Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy
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 rec...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2023.1175237/full |
| _version_ | 1797803528452833280 |
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| author | Takahisa Hiramitsu Yuki Hasegawa Kenta Futamura Manabu Okada Norihiko Goto Shunji Narumi Yoshihiko Watarai Yoshihiro Tominaga Toshihiro Ichimori |
| author_facet | Takahisa Hiramitsu Yuki Hasegawa Kenta Futamura Manabu Okada Norihiko Goto Shunji Narumi Yoshihiko Watarai Yoshihiro Tominaga Toshihiro Ichimori |
| author_sort | Takahisa Hiramitsu |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T05:22:13Z |
| format | Article |
| id | doaj.art-5c17e54a803f499fa1b215a9229ed876 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-03-13T05:22:13Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj.art-5c17e54a803f499fa1b215a9229ed8762023-06-15T10:58:30ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922023-06-011410.3389/fendo.2023.11752371175237Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomyTakahisa HiramitsuYuki HasegawaKenta FutamuraManabu OkadaNorihiko GotoShunji NarumiYoshihiko WataraiYoshihiro TominagaToshihiro IchimoriIntroductionFollowing 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.https://www.frontiersin.org/articles/10.3389/fendo.2023.1175237/fullsecondary hyperparathyroidismparathyroidectomyrecurrent secondary hyperparathyroidismautograftparathyroid gland |
| spellingShingle | Takahisa Hiramitsu Yuki Hasegawa Kenta Futamura Manabu Okada Norihiko Goto Shunji Narumi Yoshihiko Watarai Yoshihiro Tominaga Toshihiro Ichimori Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy Frontiers in Endocrinology secondary hyperparathyroidism parathyroidectomy recurrent secondary hyperparathyroidism autograft parathyroid gland |
| title | Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy |
| title_full | Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy |
| title_fullStr | Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy |
| title_full_unstemmed | Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy |
| title_short | Maximal parathyroid gland diameter as a predictive factor for autograft-dependent recurrent secondary hyperparathyroidism after total parathyroidectomy |
| title_sort | maximal parathyroid gland diameter as a predictive factor for autograft dependent recurrent secondary hyperparathyroidism after total parathyroidectomy |
| topic | secondary hyperparathyroidism parathyroidectomy recurrent secondary hyperparathyroidism autograft parathyroid gland |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2023.1175237/full |
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