Successful parathyroid gland autotransplantation after total parathyroidectomy in dialysis patients.

Secondary hyperparathyroidism is one of the major complications encountered in patients on maintenance dialysis. Medical management is frequently unsuccessful, and there is often a need to perform a parathyroidectomy. Recurrent clinical secondary hyperparathyroidism may occur as a sequela of subtotal parathyroidectomy and necessitate a reexploration of the neck. Total parathyroidectomy followed by autotransplantation of parathyroid tissue into the patient's forearm bypasses the need for a second operation, and it provides a simple ambulatory procedure, under local anesthesia, for the removal of hyperplastic parathyroid tissue. The results in six patients indicate that this new procedure should be considered the treatment of choice for this condition.