Graft survival rate and its influence on calcium and phosphorus metabolism after total parathyroidectomy and auto-transplantation in patients with secondary hyperparathyroidism / 中华肾脏病杂志

ABSTRACT

Objective:To investigate the graft survival rate after total parathyroidectomy (TPTX) plus forearm muscle auto-transplantation in patients with secondary hyperparathyroidism (SHPT) and evaluate the effect of graft survival status on calcium and phosphorus metabolism.Methods:It was a retrospective cohort study. The end-stage renal disease patients who were diagnosed with SHPT and underwent TPTX plus forearm muscle auto-transplantation from November 2015 to December 2018 at the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled. The clinical data including serum calcium, phosphorus, intact parathyroid hormone and alkaline phosphatase preoperative and postoperative 1 week, 1 month and 6 months, and cumulative requirements of calcium carbonate and calcitriol in postoperative 1 month and 6 months were collected. The graft survival rate was summarized and the differences of serum calcium, phosphorus, and supplementation dosage of calcium and calcitriol after surgery between the graft survival group and the graft non-survival group were compared.Results:A total of 191 patients were included in the study, with 95 males (49.7%), and 172 patients of age <60 years old. There were 154 grafts surviving with a graft survival rate of 80.6%. There were no significant differences in the levels of serum calcium, phosphorus, alkaline phosphatase at 1 week, 1 month and 6 months after surgery, and cumulative dosage of calcium carbonate at 1 month and 6 months after surgery between the two groups (all P>0.05). The dose of calcitriol in the graft non-survival group was significantly higher than that in the graft survival group within 1 month after surgery [41.50 (30.00, 45.00) μg vs. 32.75 (25.50, 40.50) μg, Z=-2.307, P=0.021]. However, there was no significant difference in cumulative calcitriol supplementation between the two groups within 6 months after surgery ( P>0.05). Conclusions:The graft survival rate after TPTX plus forearm muscle auto-transplantation is high in SHPT patients. Within 6 months after surgery, there is no significant difference in serum calcium, phosphorus and cumulative supplemental doses of calcium and calcitriol between the graft survival and non-survival groups.