Short- and long-term outcome of total parathyroidectomy with immediate autografting versus subtotal parathyroidectomy in patients with end-stage renal disease

A retrospective study was performed in 36 patients with end-stage renal dis ease (ESRD) comparing total parathyroidectomy followed by immediate autogra fting into the forearm (total PTX + IA) with parathyroidectomy (subtotal PT X) over a five-year period. Twenty-eight patients underwent subtotal PTX an d 8 had total PTX + IA. The two surgical methods were evaluated with respec t to preoperative severity of hyperparathyroidism, perioperative morbidity, and the incidence of recurrent hyperparathyroidism. Eleven patients in tot al (30.6%) developed recurrent hyperparathyroidism; 2/8 (25%) in the total PTX + IA group compared to 9/28 (32.1%) in the subtotal PTX group (p = 0.69 9). The median time to recurrence was longer in the total PTX + IA group (3 9 vs. 16 months), and the median long-term postoperative PTH value was lowe r (81 vs. 199 ng/l), but these differences did not reach statistical signif icance. In conclusion, the incidence of recurrent hyperparathyroidism is hi gh regardless of surgical modality. However, total PTX + IA may produce mor e favorable results with respect to median postoperative PTH level and time to recurrence. Copyright (C) 1999 S. Karger AG, Basel.