Explorative parathyroidectomy before and after kidney transplantation.

Twentytwo parathyroidectomies were performed in a series of about 200 patients. Surgical exploration was performed in less than 5% of patients with slowly progressive uremia, and of patients on maintenance haemodialysis, whereas as many as 15% of patients returning to dialysis after graft failure were operated on. After successful transplantation appoximately 10% of a patients with an initially functioning graft ultimately had a neck exploration. On three occasions this parathyroidectomy was acutely performed. In about one third of the surgically explored cases the parathyroid glands displayed marked assymetry and/or histological features possibly indicative of adenoma formation or "autonomous nodules". The incidence of surgical complications was low and beneficial clinical effect were often encountered. It thus seems possible to defend a liberal attitude towards the performance of parathyroidectomy in patients accepted into a transplantation programme.