Abstract
Total parathyroidectomy and autotransplantation of parathyroid tissue (PTX-AT) is reasonable therapy for patients with renal osteodystrophy (ROD) resistant to conservative therapy. PTX-AT were performed on 31 hemodialysis patients in our hospital. Two patients were followed up more than 4 years after surgery, and 16 patients were followed up more than 2 years. Serum Ca decreased rapidly after surgery but was maintained by Ca replacement therapy, and serum P decreased after PTX-AT, however, gradually increased and attained preoperative levels one year after surgery. Serum C-PTH decreased immediately after surgery and remained at low levels in most patients. Elevation of C-PTH (>5ng/ml) after surgery occurred in 7 patients. One of the 7 patients had recurrence in autotransplanted parathyroid tissue, 4 had recurrence in residual parathyroid, and 2 had no signs of recurrence in imaging studies. The skeleton was examined radiologically before and after surgery. Salt-and-pepper appearance of the skull and tuft-resorption of the finger bones improved markedly in 67% and 74%, respectively. However, the rugger jersey appearance of the spine improved in only 43%. The metacarpal index increased significantly from 47.1% to 51.1%, and it featured an increase in cortical bone. On the other hand, progression and no change in vascular calcification were found in 14 of the 16 patients after PTX-AT. One patient died of myocardial infarction in spite of radiological improvement in the bones. PTX-AT is considered effective therapy for ROD in hemodialysis patients, however, it cannot be expected to improve cardiovascular calcification.
