Surgical management of renal hyperparathyroidism with total parathyroidectomy, autotransplantation, and cryopreservation with deferred autotransplantation: A 13-year experience.

OBJECTIVE

Secondary and tertiary hyperparathyroidism in children with chronic kidney disease (CKD) require complex management. Surgical intervention aims to reduce parathyroid hormone (PTH) levels in CKD patients, thereby preventing complications associated with hyperparathyroidism (HPT). We describe our 13-year experience in the surgical management of secondary and tertiary hyperparathyroidism in pediatric patients, including total or subtotal parathyroidectomy, autoimplantation, cryopreservation, and deferred autoimplantation.

METHODS

An observational and analytical retrospective cohort study was carried out, with pediatric patients diagnosed with secondary or tertiary hyperparathyroidism who underwent total or subtotal parathyroidectomy, autoimplantation, and cryopreservation between 2011 and 2024 were included. Two patients who underwent deferred autoimplantation were also included. Patients lacking pathological or surgical data were excluded. Variables analyzed included age, calcium and phosphate levels, PTH, alkaline phosphatase (ALP), follow-up duration, and complications.

RESULTS

Twenty-two patients (16 males) with a mean age of 15.5 years (range 10-19) were included. The median preoperative PTH level was 2146 pg/mL [1218-2728]. Intraoperative PTH measurement showed a median reduction of 91 % within 15 min [83-95]. The median duration of postoperative intravenous calcium therapy was 4 days [2-5]. Pre-surgical localization of parathyroid glands was challenging, with ultrasound proving superior to scintigraphy in detecting gland hyperplasia. Combining both methods may maximize diagnostic accuracy. Both patients undergoing deferred autoimplantation achieved improvement of PTH and serum calcium; one required oral calcium supplementation but had no further hospital admissions for intravenous calcium.

CONCLUSION

Total parathyroidectomy with autoimplantation is a safe and effective treatment for secondary and tertiary HPT in pediatric patients, potentially preventing bone complications. Deferred autoimplantation and cryopreservation showed promising results in long-term management and quality of life.