Total parathyroidectomy for posttransplantation hyperparathyroidism

The acute and short-term clinical course of 19 subjects who underwent total parathyroidectomy and forearm implantation for persistent hyperparathyroidism following successful kidney transplantation (mean [±SD] time after transplant 43.7±29.5 months) is described. Their mean preoperative serum calcium level of 10.8±0.5 mg% decreased to a nadir of 7.9±0.9 mg%, 62.5±27.7 hr after the operation. The lowest serum ionized calcium (1.80±0.2 mEq/L) was recorded 57±49 hr postoperatively. After an average of five hospital days. the patients were discharged with a mean serum total calcium concentration of 8.3±1.0 mg%. Three months following the operation, the mean serum total calcium concentration was 9.5±0.6 mg%. With an average follow-up of 19 months (range 3–36 months) serum total calcium was 9.6±0.6 mg%, with only one subject requiring calcium supplementation. Total parathyroidectomy with forearm implantation was associated with normalization of serum-immunoreactive parathyroid hormone concentrations and maintenance of stable allograft function. Our experience suggest that this procedure is an effective modality with a predictable postoperative recovery of parathyroid function when used to treat persistent hyperparathyroidism in the long-term survivor of renal transplantation.