Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy

Frontiers in Endocrinology

Endocrinology

Manabu Okada¹  Yuki Hasegawa¹  Yoshihiro Tominaga¹  Toshihiro Ichimori¹  Kenta Futamura¹  Norihiko Goto¹  Shunji Narumi¹  Yoshihiko Watarai¹  Takahisa Hiramitsu¹ 

[1] Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan;

关键词: secondary hyperparathyroidism;    parathyroidectomy;    recurrent secondary hyperparathyroidism;    autograft;    parathyroid gland;   

DOI  :  10.3389/fendo.2023.1175237

 received in 2023-02-27, accepted in 2023-05-30,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionFollowing total parathyroidectomy (PTx), transcervical thymectomy, and forearm autograft for secondary hyperparathyroidism (SHPT), recurrent SHPT can occur in the autografted forearm. However, few studies have investigated the factors contributing to re-PTx due to autograft-dependent recurrent SHPT before the completion of the initial PTx.MethodsA total of 770 patients who had autografted parathyroid fragments derived from only one of the resected parathyroid glands (PTGs) and who had undergone successful initial total PTx and transcervical thymectomy—defined by serum intact parathyroid hormone level < 60 pg/mL on postoperative day 1—between January 2001 and December 2022 were included in this retrospective cohort study. Factors contributing to re-PTx due to graft-dependent recurrent SHPT before the completion of the initial PTx were investigated using multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimal maximum diameter of PTG for autograft.ResultsUnivariate analysis showed that dialysis vintage and maximum diameter and weight of the PTG for autograft were significant factors contributing to graft-dependent recurrent SHPT. However, multivariate analysis revealed that dialysis vintage (P=0.010; hazard ratio [HR], 0.995; 95% confidence interval [CI], 0.992–0.999) and the maximum diameter of the PTG for autograft (P=0.046; HR, 1.107; 95% CI, 1.002–1.224) significantly contributed to graft-dependent recurrent SHPT. ROC curve analysis showed that < 14 mm was the optimal maximum diameter of PTG for autograft (area under the curve, 0.628; 95% CI, 0.551–0.705).ConclusionsThe dialysis vintage and maximum diameter of PTG for autograft may contribute to re-PTx due to autograft-dependent recurrent SHPT, which can be prevented by using PTGs with a maximum diameter of < 14 mm for autograft.

【 授权许可】

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Copyright © 2023 Hiramitsu, Hasegawa, Futamura, Okada, Goto, Narumi, Watarai, Tominaga and Ichimori