Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: A retrospective cohort study.
BACKGROUND
Intramuscular and subcutaneous forearm parathyroid autograft are proved to have compatible short-term outcome. However, long-term clinical courses have not been studied.


METHODS
A single-surgeon retrospective cohort study of parathyroid autograft hyperplasia from August 1998 to January 2013 was performed. According to the location of their parathyroid autograft, patients were divided into an Intramuscular group and a Subcutaneous group. Clinical parameters were analyzed to assess the risk factors and clinical course of autograft hyperplasia.


RESULTS
There were 888 consecutive patients who underwent total parathyroidectomy with forearm autotransplantation for renal hyperparathyroidism during the period. The median age at the time of total parathyroidectomy with forearm autotransplantation was 54.2 years (range, 12-86) and the median follow-up time was 4.0 years (range 0.1-16). Autograftectomy was performed on 29 of 888 patients. The incidence of autograftectomy was 15 of 65 in the Intramuscular group and 14 of 823 in the Subcutaneous group; the incidence of repeated autograftectomy was 4 of 65 in the Intramuscular group and 1 of 823 in the Subcutaneous group. The cumulative frequency of autograftectomy was greater in the Intramuscular group than that in the Subcutaneous group (11.6 vs 3.1% at 6 years, P < .001). The location of the autograft was the only significant factor affecting the autograftectomy frequency (P = .002). The Intramuscular group reoperation patients experienced a longer period between their first operation and the autograftectomy (6.6 vs 3.3 years, P = .003), longer operating times (79 vs 37 minutes, P = .002), and a greater level of pre-autograftectomy systemic intact parathyroid hormone (1,044 vs 559 ng/L, P = .014) than the Subcutaneous group.


CONCLUSION
Intramuscular parathyroid autotransplantation results in a high incidence of autograftectomy, repeated autograftectomy, and a high cumulative frequency of autograftectomy.