Purpose: Persistent hypercalcemia after parathyroidectomy (PTx) remains a significant concern in patients with tertiary hyperparathyroidism (THPT) following kidney transplant (KT).Complete resection of hyperfunctioning glands is challenging due to ectopic or intrathyroidal glands.This study evaluated whether intraoperative parathyroid hormone (ioPTH) monitoring during PTx in KT patients with THPT reduces the surgical failure rate.Methods: We retrospectively analyzed 111 patients with THPT who underwent PTx at a single tertiary center.Patients were divided into 2 groups: those without ioPTH monitoring (n=98) and those with ioPTH monitoring (n=13).Surgical procedures included less than subtotal, subtotal, or total PTx with autotransplantation.Surgical failure was defined as persistent hypercalcemia (serum calcium 10.3 mg/dL and intact parathyroid hormone PTH >65 pg/mL) on postoperative day 1 (POD1) or at 6 months postoperatively. Results:The ioPTH group demonstrated a significantly lower mean PTH level on POD1 (2115.3pg/mL vs. 3939 pg/mL; P=0.006).Although not statistically significant, the ioPTH group showed a higher biochemical cure rate at 3 months (53.8% vs. 30.6%)and no cases of persistent hyperparathyroidism, compared to 15.3% in the non-ioPTH group.Despite adequate intraoperative PTH reduction, some patients in both groups exhibited isolated PTH elevation without hypercalcemia.Conclusion: Although ioPTH monitoring did not significantly reduce the surgical failure rate in PTx for THPT, the use of ioPTH may meaningfully improve surgical completeness and reduce the risk of persistent or recurrent hyperparathyroidism, suggesting its substantial potential value as an intraoperative.
Chung et al. (Thu,) studied this question.
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