(191) Extent of Parathyroidectomy for the Treatment of Tertiary Hyperparathyroidism

Introduction: Prompt management of patients with aberrant parathyroid hormone secretion after renal transplant is necessary to avoid allograft dysfunction and osteoporosis. Parathyroidectomy (PTX) maybe curative but extent is controversial. Practice patterns vary as avoiding persistent disease must be weighed against risks to the transplanted kidney and hypocalcemia.

Methods: Retrospective review of all patients undergoing parathyroidectomy for tertiary hyperparathyroidism at a single tertiary care institution between 2011-2021 was performed under IRB approval. Normalization of serum calcium at 6 months was evaluated. Secondary outcomes included graft function and clinical hypocalcemia.

Results: A total of 20 patients were identified, 11 receiving subtotal or total parathyroidectomy (PTX) and 9 partial PTX. Baseline biochemical profile was similar between the two groups though patients undergoing total/subtotal PTX had a greater intraoperative reduction in PTH (83.11% vs. 65.12%, p=0.043). Patients who underwent total/subtotal PTX required a longer hospital stay(3.5 vs. 2, p=.044). The was no difference in rate of eucalcemia at 6 months (81.8% vs. 88.9%, p=0.579) between the groups. There was no difference in reduction in GFR at 6 months (11.5% vs. 9.3%, p=0.93). All episodes of post-op hypocalcemia (n=5) occurred in the total/subtotal PTX group (p=0.038).

Conclusions: In patients with tertiary hyperparathyroidism, similar rates of eucalcemia are observed after different extents of parathyroidectomy. Patients undergoing subtotal/total PTX had longer hospital stays and more frequent clinical hypocalcemia. Although our study shows no significant differences to renal transplant function, this is limited by sample size and disease incidence. Larger, multi-institutional studies are needed to clarify the ideal surgical management of tertiary hyperparathyroidism.