Recurrences are not uncommon following surgery with total or subtotal parathyroidectomy for renal hyperparathyroidism. The aim of this study was to investigate the impact of recurrence following total parathyroidectomy and auto-transplantation on mortality.

Retrospective cohort review of patients who underwent parathyroidectomy from 2000-2022 at a tertiary referral center in a developed nation from Southeast Asia. Demographics, biochemistry, treatment parameters and outcomes were analyzed using univariate and multivariate analysis for factors predictive of recurrence. Statistical value P< 0.05 considered significant.

33 of 195 (17%) patients developed recurrence during a mean follow up of 8.7 years. The mean age of the patients were 56.7 years (SD 13.3; range 22 - 75) with a female: ratio of 1.5:1. The mean pre-excision biochemical indices at index surgery were the following: PTH (258.6pmol/L), corrected serum calcium (2.65mmol/L), serum phosphorus (1.98mmol/L) and serum alkaline phosphatase (353U/L). The mean PTH values at recurrence was 105.9pmol/L and post excision of recurrence 27.6pmol/L. The sites of recurrences were seen in the deltoid auto transplant in 30 patients and in the mediastinum in 3 patients. The recurrence appeared after a mean time of 2.8 (range 1 - 6) years with a dialysis vintage of 5.5 (range 1-9) years. In terms of intervention, 21 of 33 underwent explant of the deltoid auto transplant and 1 excised from the mediastinum. Cohort mortality was 51 of 195 (26%) and was the only factor impacted by recurrence (p=0.04).

Recurrence is not uncommon following total parathyroidectomy and has an impact on mortality.