Morbidity and long-term outcome of surgery for renal hyperparathyroidism: results from a prospective cohort

Abstract

Purposes

Surgery remains an important treatment option for renal hyperparathyroidism (rHPT). The number of long-term outcome studies of parathyroidectomy is limited.

Methods

All consecutive patients with a parathyroidectomy for rHPT between 09/2009 and 04/2021 in a Belgian tertiary referral hospital were prospectively enrolled. The main outcomes were (long-term) cured proportion and postoperative morbidity (hypocalcemia, recurrent laryngeal nerve (RLN) palsy, re-intervention for bleeding, and wound morbidity).

Results

Sixty patients with a median age of 57 years were analyzed, including 23 patients before kidney transplantation, 23 patients without kidney transplantation, and 14 patients after kidney transplantation. Median time to transplant was 15 (6–24) months after parathyroidectomy. Morbidity was low with only two non-urgent returns to theatre (wound infection and non-compressive hematoma), two temporary RLN paralyses, and no 30-day mortality. Length of hospital stay was longer in patients with parathyroidectomy before kidney transplant, due to a more severe and prolonged need for calcium supplementation. After a median follow-up of 63 months, 37 patients (62%) were still alive, and 11 patients (18%) developed a recurrence.

Conclusions

This single-surgeon, single-center cohort with long-term follow-up confirms the safety and excellent ‘cure’ proportions of surgery for rHPT but stretches the importance of long-term follow-up.

Keywords:

• Renal hyperparathyroidism
• surgery
• outcome
• morbidity

Author contributions

Klaas Van Den Heede: Study conception and design – Acquisition of data – Analysis and interpretation of data – Drafting of the manuscript – Critical revision of the manuscript. Thibaut Claerhout: Acquisition of data – Analysis and interpretation of data – Drafting of the manuscript. Sophie Jansen: Acquisition of data – Critical revision of the manuscript. Simon Blontrock: Acquisition of data – Critical revision of the manuscript. Nele Brusselaers: Study conception and design – Analysis and interpretation of data – Critical revision of the manuscript. Sam Van Slycke: Study conception and design – Analysis and interpretation of data – Critical revision of the manuscript.

Disclosure statement

All authors have no conflicts of interest. The results presented in this paper have not been published previously in whole or part. There are no prior publications or submissions with any overlapping information. All authors are responsible for the reported research and have all participated in the concept and study design, analysis and interpretation of data, drafting of the manuscript, or revision of the manuscript. The final manuscript has been approved by all authors.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.