Persistent hyperparathyroidism requiring surgical treatment after kidney transplantation

There are not many publications describing long-term follow-up of persisten t hyperparathyroidism requiring surgical treatment after kidney transplanta tion (PHSKT). In some patients adenomas, rather than multiglandular disease , have been incriminated as the cause of PHSKT. We reviewed the charts of 4 5 patients followed for 12 to 146 months (median 45 months) after parathyro idectomy for PHSKT. We compared them with (1) those of 951 patients receivi ng a kidney graft during the same period but not submitted to parathyroidec tomy or (2) 90 matched controls selected from this cohort to determine the characteristics of PHSKT patients. The duration of pretransplant dialysis w as significantly longer in PHSKT patients than in controls (5.78 +/- 0.41 v s. 3.41 +/- 0.24 years; p < 0.0001). A total of 166 glands were removed or biopsied. Except for one questionable case, no true adenoma was observed ev en when only one gland was enlarged. The outcome of surgery was not influen ced by the technique (subtotal parathyroidectomy versus total parathyroidec tomy and autografting) but depended on the amount of resected parathyroid t issue: no failures and 4 cases of hypoparathyroidism in 34 cases with no mi ssing gland at cervical exploration; 3 failures and no permanent hypoparath yroidism in 11 cases with one or two missing glands. Excision of the enlarg ed glands only was sufficient to cure the patient. No recurrence was observ ed. Our results suggest that single gland enlargement in PHSKT results in m ost cases from different rates of involution of the parathyroids after succ essful kidney transplantation. When fewer than four glands are discovered, resection of all visible glands with or without grafting corrects hypercalc emia in more than 70% of the cases.