total parathyroidectomy alone or with autotransplantation for secondary hyperparathyroidism in end stage renal disease patients a systematic review and meta analysis

Abstract Purpose: Secondary Hyperparathyroidism (SHPT) is one of the major complications of End-Stage Renal Disease (ESRD) patients. There is ongoing debate on the quality of surgical interventions for these patients. A systematic and meta-analysis was conducted to compare the efficacy and safety of Total Parathyroidectomy (TPTX) alone versus total Parathyroidectomy with auto transplantation (TPTX + AT) on ESRD patients. Methods: A literature search was undertaken among Cochrane Library, Medline and Embase from inception up to October 2019. Primary outcome included recurrent or persistent SHPT, recurrent SHPT and persistent SHPT. Risk Ratio (RR) was calculated using a fixed effect model. Results: A total of 4 studies (3 randomized controlled trials and 1 prospective cohort study) comprising 264 patients were analyzed. Compared with TPTX, patients with TPTX + AT have higher risk of “recurrent SHPT” (RR 4.30, 95% confidence interval (CI) 1.13-16.38, P=0.03) and “recurrent or persistent SHPT” (RR 2.89, 95% CI 1.25-6.71, P=0.01, I2=0%). TPTX had shorter operative time than TPTX+AT, but was associated with higher risk of postoperative hypoparathyroidism. No significant difference was found between two groups regarding “persistent SHPT”, “effective”, “ineffective”, duration of hospital stay, permanent recurrent laryngeal nerve palsy or death rate during follow-up. Conclusions: TPTX as compared with TPTX + AT was associated with a significant reduction in “recurrent SHPT” and “recurrent or persistent SHPT”, and was not associated with an increase in postoperative side effect or mortality. Our findings favored TPTX in the treatment of SHPT in ESRD patients. Keywords Chronic; Hyperparathyroidism; Kidney failure; Meta-analysis; Parathyroidectomy; Secondary