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Nephrol Dial Transplant (1987) 2: 341-346
© 1987 European Renal Association-European Dialysis and Transplant Association

research-article

Total Parathyroidectomy With Autotransplantation in Haemodialysed Patients With Secondary Hyperparathyroidism—Should It Be Abandoned?

Z. Korzets1, H. Magen1, L. Kraus2, J. Bernheim3, and J. Bernheim1

1Department of Nephrology, Meir General Hospital, Kfar Saba and Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel 2Departments of Surgery A, Meir General Hospital, Kfar Saba and Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel 3Department of Pathology, Meir General Hospital, Kfar Saba and Sackler School of Medicine, Tel Aviv University Tel Aviv, Israel

Correspondence and offprint requests to: Correspondence and offprint requests to: Prof. J. Bernheim, Department of Nephrology, Meir Hospital, Kfar Saba, Israel.

The development of secondary hyperparathyroidism is almost universal in patients with end-stage renal disease. Medical management frequently fails and in such circumstances parathyroidectomy becomes a necessity. Total parathyroidectomy with autotransplantation of parathyroid tissue into the patient's forearm has been advocated as the surgical procedure of choice. In a previous publication we reported our experience with this technique in six haemodialysed patients. We now extend our follow-up to 19 patients over an observation period ranging from 6 to 66 months. Five of these patients required graft removal because of recurrent secondary hyperparathyroidism. Despite total graft removal, two patients had clinical and laboratory evidence of persistent hyperparathyroidism. Histology of the removed graft tissue demonstrated severe hyperplasia as well as invasion of adjacent muscle, adipose tissue, and vascular channels by parathyroid cells. This raises the possibility of local and distant metastatic spread of parathyroid tissue resulting in hyperparathyroidism. We suggest that parathyroid autotransplantation is potentially hazardous and should in fact be abandoned.

Keywords: Parathyroidectomy; Parathyroid autotransplantation; Haemodialysis; Secondary hyperparathyroidism


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