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Abstract: TH-PO922

Value of Intra-Operative PTH Assay during Parathyroidectomy in Renal Transplant Recipients with Secondary and Tertiary Hyperparathyroidism

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Wang, Kevin, University of Kentucky, LEXINGTON, Kentucky, United States
  • Edon, Adeleye Annick, University of Kentucky, LEXINGTON, Kentucky, United States
  • Saxon, David, University of Kentucky, LEXINGTON, Kentucky, United States
  • Lima, Florence, University of Kentucky, LEXINGTON, Kentucky, United States
  • Sloan, David, University of Kentucky, LEXINGTON, Kentucky, United States
  • Sawaya, B. Peter Emile, University of Kentucky, LEXINGTON, Kentucky, United States
  • Mohamed, Amr El-Husseini, University of Kentucky, LEXINGTON, Kentucky, United States
Background

In renal transplant patients with secondary and tertiary hyperparathyroidism (HPT), the association between intra-operative parathyroid hormone (ioPTH) levels during parathyroidectomy (PTX) and long-term PTH is unknown. The present study aims at evaluating the value of ioPTH measurements on long-term outcome of PTX in renal transplant recipients in a single center study.

Methods

The ioPTH was measured in 18 renal transplant recipients (12 males and 6 females) who underwent PTX from 2005 to 2015 because of persistent hyperparathyroidism post-transplant. Near-total PTX was performed in 13 patients and total PTX in 5 patients. The ioPTH monitoring included 3 samples: pre-intubation (pre-ioPTH), 10- and 20-minute post parathyroid gland excision (10-ioPTH and 20-ioPTH). Patients were followed for up to 5 years (mean ± SD: 2.5 ± 1.6 years).

Results

The median (25th-75th percentile) pre-, 10- and 20-ioPTH levels were: 273 pg/ml (173-411), 42 pg/ml (22-73) and 34 pg/ml (20-50), respectively. All patients had a functional kidney transplant at time of surgery with a median serum creatinine of 1.3 mg/dl (1.2-1.7) and eGFR of 55 ml/min (40-60). The median time between renal transplant and PTX surgeries was 22 months (7-81). The median last follow-up PTH level was 59 pg/ml (17-83). There was no significant difference between 20-ioPTH and follow-up PTH measurements (P=0.6). The pre- PTX and follow-up PTH levels are shown in the Figure. Three patients (17%) were readmitted within 90 days because of hypocalcemia. Apart from easily treated hypocalcemia, the PTX surgeries were uneventful. No patient required repeat PTX because of recurrent HPT.

Conclusion

The 20-ioPTH is a good indicator of long-term PTH measurements. There were minimal complications associated with the procedure.