Long-Term Outcomes of Total Parathyroidectomy With or Without Autoimplantation for Hyperparathyroidism in Chronic Kidney Disease: A Meta-Analysis

The aim of the present study was to compare total parathyroidectomy without autotransplantation (TPTX) versus total parathyroidectomy with autotransplantation (TPTX+AT) for renal hyperparathyroidism (RHPT) with respect to long-term outcomes. A literature search was undertaken using Medline and EMBASE from inception to December 2013. Data were analyzed using Review Manager version 5.0. A total of seven cohort studies comprising 931 patients were identified. Compared with TPTX+AT, patients in the TPTX group have lower recurrence (odds ratio (OR) 0.08, confidence interval (CI) 0.03 to 0.21; P<0.00001), lower recurrence or persistence(OR 0.11, 95% CI 0.05 to 0.25; P<0.00001), lower requiring reoperation because of recurrence or persistence (OR 0.17, CI 0.06 to 0.54; P=0.002), and higher hypoparathyroidism (OR 2.97, CI 1.09 to 8.08; P=0.03). None of the patients in these seven studies were recorded as having severe hypocalcemia or adynamic bone disease. Compared with TPTX+AT, TPTX is associated with lower requiring reoperation because of recurrence or persistence and without severe hypocalcemia or adynamic bone disease.