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Secondary Hyperparathyroidism: Recurrence after Total Parathyroidectomy with Autotransplantation

Steffen, Lukas and Moffa, Giusi and Müller, Philip C. and Oertli, Daniel. (2019) Secondary Hyperparathyroidism: Recurrence after Total Parathyroidectomy with Autotransplantation. Swiss Medical Weekly, 149. w20160.

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Official URL: https://edoc.unibas.ch/81041/

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Abstract

Secondary hyperparathyroidism is common in patients with end-stage chronic kidney disease. If drug therapy fails, total parathyroidectomy with autotransplantation of parathyroid tissue into the forearm (PTX-AT) is the most widely used procedure. High recurrence rates of secondary hyperparathyroidism following PTX-AT are reported in the literature. The aim of this study was to evaluate recurrences of secondary hyperparathyroidism following PTX-AT in detail in order to develop strategies to prevent recurrences in the future. This retrospective study analysed a single-centre cohort of 42 patients who underwent PTX-AT for secondary hyperparathyroidism at a tertiary centre in Switzerland. Postoperative PTH levels were evaluated to determine the recurrence and persistence rates and the time to recurrence. Furthermore, the peri- and postoperative outcomes were assessed. Patients on dialysis and patients with a functioning kidney transplant suffering tertiary HPTH were analysed separately. Intraoperative measurements showed that serum PTH decreased to 6.9% (3.3–15.0%) of the preoperative baseline level. After a median follow-up of 89.5 months (IQR 31.9–152.9), persistence of secondary hyperparathyroidism was found in five patients (11.9%) and recurrence in four patients (9.5%), giving a total recurrence rate of 21.4%. Recurrence of secondary hyperparathyroidism after PTX remains a problem, occurring in every fifth patient. In our experience, the introduction of intraoperative PTH measurement has helped to lower the rates of persistence and recurrence. Further reductions in the recurrence rate might be achieved with novel, more accurate pre- and intraoperative imaging techniques.
Faculties and Departments:05 Faculty of Science > Departement Mathematik und Informatik > Mathematik > Statistik (Moffa)
UniBasel Contributors:Moffa, Giusi
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:EMH Schweizerischer Ärzteverlag
e-ISSN:1424-3997
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:13 Apr 2021 14:29
Deposited On:13 Apr 2021 14:29

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