Impacts Of Total Parathyroidectomy With Auto-Transplantation On Prognosis And Quality Of Life In Maintenance Hemodialysis Patients With Secondary Hyperparathyroidism

Objective This study was conducted to investigate the survival rate of grafts after total parathyroidectomy with auto-transplantation(PTX+AT)and its impacts on prognosis and quality of life in maintenance hemodialysis patients with secondary hyperparathyroidism(SHPT).Methods 160 maintenance hemodialysis(MHD)patients underwent PTX+AT were recruited from Second Affiliated Hospital of Anhui Medical University between February 1th,2011 and November 31 th,2015.2 weeks after operation,the allograft function was evaluated via comparing serum intact parathyroid hormone(iPTH)levels between implanted and non-implanted arm.Biochemical parameters were detected preand 1 month,3 months,6 months,9 months,12 months post-operation.Clinical symptoms and complications were collected.Results 1.The grafts survival rate was 66.25%.Bone pain and pruritus were remarkably improved in both groups after operation.2.Compared with the preoperative parameters,the levels of Ca(ionized),P,iPTH and alkaline phosphatase(ALP)dropped significantly in both groups(P<0.05),and the hemoglobin(Hb),albumin(Alb)and total protein(TP)levels increased markedly in both groups(P<0.05).Between the two groups,the levels of Ca at 3 months and 12 months post-operation in survival group were significantly higher than the compared one.The iPTH level at 12 months post-operation in survival group was also dramatically higher than non-survival group.There were no significant differences in other indicators between the two groups.Although the patients readmitted due to hypocalcemia in non-survival group were slightly more than those in survival group,severe hypocalcemia was more common in the patients with longer dialysis vintage,higher PTH value and severer bone pain pre-operation in both groups.3.1 patient was dead in survival group compared with 2 patients in the other one until 1 year of follow-up.The recurrence rate of survival group was higher(10/106 vs.2/54,P < 0.05).Conclusions There were no significant differences on prognosis and life of quality among two groups after operation.So total parathyroidectomy without auto-transplantation(tPTX)can be suggested as one of the approaches to SHPT,which can not only reduce the operation time and cost,but also reduce the recurrence rate?The occurrence of hypocalcemia after operation was positively correlated with the severity of SHPT.