Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation for Secondary Hyperparathyroidism in Dialysis Patients: Short and Long Term Outcomes
*Polina Zmijewski1, *Jonathan Staloff2, *Madeline Wozniak1, Peter J Mazzaglia1
1Rhode Island Hospital, Providence, RI;2Alpert School of Medicine, Providence, RI
Objective:Compare the immediate and long- term outcomes of subtotal parathyroidectomy (SPTX) vs. total parathyroidectomy with autotransplantation (TPTX-AT) for dialysis patients with secondary hyperparathyroidism
Design:Retrospective review
Setting: 719 bed tertiary care academic medical center
Patients: 48 dialysis patients undergoing parathyroidectomy between 2006 and 2017
Interventions: 25 had SPTX and 23 had TPTX-AT
Main Outcome Measures: Post- operative day 1 calcium and PTH, hospital length of stay, duration and severity of postoperative hypocalcemia, and reoperation for recurrence, long term hypoparathyroidism
Results: Pre-operative age, calcium and PTH were similar. Post- op day 1 calcium and PTH values were 8.3±1 and 31.5±48.9 for SPTX, and 8.1±1.3 and 16.5±25.3 for TPTX-AT (p>.05). Hospital length of stay was 2.2±1.6 days for SPTX and 3.2±3 days for TPTX-AT (p=.07). Total gland weight submitted to pathology was 1.997±1.6 gm for SPTX and 4.43±5.19 gm for TPTX. The required doses of calcium and calcitriol at discharge did not significantly differ. Most recent PTH > 6 months post-op was 99.8±103 for SPTX and 48.1±64 for TPTX-AT (p=.02), and simultaneous calcium was 8.9±1.7 for SPTX and 8.5±1.9 for TPTX-AT (p=.6). Re-operation for recurrence was required in 3 SPTX and no TPTX-AT. PTH values< 15 at long term follow up occurred in 12% of SPTX and 47.8% of TPTX-AT. Long term serum calcium value < 8 occurred in 8% of SPTX and 47.8% of TPTX-AT.
Conclusions: In dialysis patients undergoing parathyroidectomy, both SPTX and TPTX-AT are curative. The long- term control of PTH elevation and avoidance of recurrent disease is improved with TPTX-AT, but comes at the expense of longer length of stay and higher risk of long- term hypoparathyroidism requiring calcium and calcitriol supplementation.
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