Total parathyroidectomy and autogenous parathyroid graft placement for treatment of hyperparathyroidism due to chronic renal failure

We treated 33 patients with chronic renal insufficiency and severe hyperparathyroidism with total parathyroidectomy and placement of an autogenous parathyroid graft in the forearm musculature. Postoperative biochemical data, symptomatic data, or both were available in 28 of the patients, of whom all but 1 showed evidence of improvement. Immunoreactive parathyroid hormone studies were made from 9 to 52 months postoperatively in 22 patients. Background immunoreactive parathyroid hormone levels markedly decreased after surgery and were in the optimum range in 18 patients. In the other four patients, immunoreactive parathyroid hormone levels remained above the optimum range, but in only one of the four did symptoms and biochemical parameters fail to improve. Gradients for immunoreactive parathyroid hormone across the forearm musculature were demonstrable in 18 of 22 patients, which proved the secretory function of the graft. One patient required resection of a portion of the grafted tissue on two occasions because of recurrent hypercalcemia. The technique of total parathyroidectomy and autogenous parathyroid grafting seems to be a valid alternative to subtotal parathyroidectomy for the treatment of uremic secondary hyperparathyroidism.