Tertiary hyperparathyroidism after renal transplantation: Surgical strategy

Background. An analysis of our experience with tertiary hyperparathyroidism (III HPT) in renal trans plantations between 1981 and 1996 runs reviewed to examine a variety of laboratory and clinical variables in this population. Methods. A total of 3233 kidney transplantations were performed; 48 patients underwent parathyroidectomy for III HPT. Five patients were excluded from analysis due to the development of renal dysfunction. The index 43 patients were divided into two groups. Group I consisted of 31 patients (72%) with either enlargement of all parathyroid glands (n = 26) or 3/4 gland enlargement (n = 5). These patients were assumed to have hyperplasia and underwent subtotal parathyroidectomy or total parathyroidectomy. Group II consisted of 12 patients (28 %) with single (7/12; 58 %) or two-gland enlargement (5/12; 42%). Group II patients underwent resection of only the enlarged glands. Results. Laboratory and clinical parameters showed no difference between the groups during long-term follow-up. Most patients in groups I and II were eucalcemic after parathyroidectomy. However, postopera tive hypercalcemia and hypocalcemia did occur in group I (mean postoperative calcium: growth, I = 9.29 +/- 0.63 mg/dL; group II = 9.42 +/- 0.58 mg/dL). Conclusions. Four gland parathyroid enlargement is a frequency finding in III HPT, although asymmet ric enlargement can occur. Histologically this represents sporadic adenomas and asymmetric hyperplasia. Intraoperative findings should dictate surgical strategy with asymmetric enlargement only the enlarged parathyroid glands should be resected.