# Outcome of subtotal parathyroidectomy for surgical treatment of hyperparathyroidism after renal transplantation

## TL;DR

Subtotal parathyroidectomy is effective for treating hyperparathyroidism after kidney transplants, but PTH levels cannot reliably predict surgical success.

## Contribution

Demonstrates that PTH levels are not reliable predictors of surgical success in treating post-transplant hyperparathyroidism.

## Key findings

- Surgical success was achieved in 87% of patients undergoing subtotal parathyroidectomy.
- No significant differences in PTH levels were found between successful and failed surgeries.
- Subtotal parathyroidectomy is a safe and effective treatment for hyperparathyroidism after renal transplantation.

## Abstract

•No statistically significant differences were observed between success and failure groups for the percentage intraoperative decay levels, as well as for the PTH absolute values on the first postoperative day.•Subtotal parathyroidectomy is an effective and safe procedure for treating renal transplant parathyroidectomy.•PTH levels remain subjective and cannot be considered as a predictor of surgical success.

No statistically significant differences were observed between success and failure groups for the percentage intraoperative decay levels, as well as for the PTH absolute values on the first postoperative day.

Subtotal parathyroidectomy is an effective and safe procedure for treating renal transplant parathyroidectomy.

PTH levels remain subjective and cannot be considered as a predictor of surgical success.

To evaluate the efficacy of STPX as a definitive treatment for Hyperparathyroidism after Renal Transplantation (HPT-RT) and determine whether there is a relationship between percentage intraoperative Parathyroid Hormone (ioPTH) decay levels and Parathyroid Hormone (PTH) values on the first postoperative day and surgical success.

This retrospective study analyzed the medical records of prospectively followed patients diagnosed with HPT-RT submitted to STPX in two tertiary hospitals (Brazilian Unified Health System ‒ SUS) for two years. Patients were allocated in two groups according to operative success (SG ‒ normalization of ionized Calcium [iCa] and PTH six months after surgery) or operative failure (FG ‒ persistence of high iCa and PTH). The percentage ioPTH decay levels and the postoperative PTH absolute values on the first postoperative day were evaluated in both groups.

Of the total sample of 31 patients, surgical treatment was successful in 27 cases (87%). No statistically significant differences were observed between the groups for the percentage ioPTH decay levels (SG = 71.51% vs. FG = 70.4%), as well as for the PTH absolute values on the first postoperative day (SG = 52.69 pg/mL vs. FG = 54.55 pg/mL).

Subtotal parathyroidectomy is an effective and safe procedure for treating HPT-RT; however, the use of PTH levels remains subjective and cannot be considered as a predictor of surgical success.