Hypoparathyroidism after total parathyroidectomy with immediate autotransplantation or subtotal parathyroidectomy for hyperparathyroidism after renal transplantation
Felipe Ferraz Magnabosco, André Albuquerque Silveira, Marília D’Elboux Guimarães Brescia, Climério Pereira do Nascimento, Sérgio Samir Arap, Fábio Luiz de Menezes Montenegro
Abstract
Introduction: Hypoparathyroidism is a nocuous complication. Parathyroidectomy (PTx) is the treatment of choice for persistent hyperparathyroidism after renal transplantation (HPT-RT). Objective: Analyze the postoperative hypoparathyroidism rate after total parathyroidectomy with immediate autotransplantation (PTxT+AT) and subtotal parathyroidectomy (PTxST), due to HPT-RT. Materials and Methods: Retrospective, cohort study of patients who underwent PTx due to HPT-RT between 2013 and 2018. The following serum parameters were analyzed before surgery, in the immediate postoperative period, and one and two years after surgery: total calcium (CaT), ionic calcium (Cai), phosphorus (P), parathormone (PTH), and creatinine; in addition, a search was conducted in the patients’ medical records to verify whether they received calcium and/or calcitriol oral supplementation at the same time intervals. Results: Thirty-eight patients underwent PTx (57.5% PTxT+AT; 42.5% PTxST). Mean CaT, Cai and P values and median PTH and creatinine values were similar. Significant difference was observed before and immediately after surgery for CaT, Cai, P, and PTH (p< 0.0001). There was also difference pre- and post-surgery for creatinine (p=0.0004 PTxT+AT; p=0.028 PTxST). The PTxST group needed less calcium supplementation (p=0.0003; p=0.01). One year after surgery, PTxT+AT and PTxST hypoparathyroidism rates were 61.9 and 11.8%, respectively (p=0.0025). Conclusion: There was similarity between the groups. Biochemical improvement was observed from the preoperative to the immediate postoperative periods in each group separately. One year after surgery, there was stability in calcium levels in both groups. Serum PTH and calcium levels tended to be higher in the PTxST group after two years. Both groups presented transient deterioration of renal function. The PTxST group needed less CaCO3 supplementation. Both techniques had satisfactory outcomes. More patients required calcium and calcitriol supplementation after PTxT+AT. The PTxST group presented a lower hypoparathyroidism rate.
Keywords
References
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Submitted date:
06/20/2021
Accepted date:
08/28/2021
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