Abstract: Objective To compare the therapeutic effects of subtotal parathyroidectomy (STPX) and total parathyroidectomy plus autologous transplantation in forearm (TPX-AT) on tertiary hyperparathyroidism (THPT) in patients with successful kidney transplantation.  Method  The patients with THPT after successful kidney transplantation and receiving STPX or TPX-AT from May 2018 to September 2021 were retrospectively reviewed. Their clinical data including age, sex, dialysis age, type of surgery, final pathological findings, preoperative biochemistry tests (serum calcium, iPTH, phosphorus, alkaline phosphatase, glomerular filtration rate, etc.) and postoperative iPTH at each following time were collected and analyzed.  Result  A total of 18 patients were included in this study, including 8 males and 10 females, with an average age of (45.56±3.46)years and an average dialysis time of (6.70±1.20)years. The patients were divided into STPX group and TPX-AT group, with 9 patients in each group. There were no significant differences in the preoperative values of mean serum calcium, phosphorus, ALP and iPTH between the two groups. At the first postoperative day, iPTH levels decreased to 98.88pg/ml and 39.39pg/ml in STPX group and TPX-AT group, respectively, but without statistical significance between the two groups (t=-1.423, P=0.181). The postoperative cure rates were 55.5% and 77.8% and the iPTH levels after the operation for 6 months were 105.52pg/ml and 151.07pg/ml in STPX group and TPX-AT group, respectively. The overall effective rate of the two groups was 61.1%; the effective rate was 55.5% in STPX group and was 66.7% in TPX-AT group.  Conclusion  The postoperative cure rate was higher in TPX-AT group than that in STPX group. However, the effective rates to THPT after the operation for 6 months were unsatisfactory in both groups. The iPTH level at the first postoperative day may be an indicator for prognosis of the THPT patients.

Key words: Tertiary hyperparathyroidism, Kidney transplantation, Subtotal parathyroidectomy, Total parathyroidectomy plus autotransplantation