Risk Factor Of Hypocalcemai Post Parathyriodectomy And The Parathyriod Grafts Survive Rate In Total Parathyriodectomy With Autotransplantation

ObjectiveSecondary hyperparathyroidism is a common complication of ESRD patients,parathyroidectomy is the effective curable method to SHPT.Because of the acute withdrawal of PTH,the incidence of bone hungry syndrome is remarkably high,and the incidence of postoperative hypocalcemia and the related risk factor deserve further exploration.TPTX+AT is the main surgical method for non-transplant patients to treat SHPT.But due to many factors,the survive rate of postoperative parathyroidism graft varies greatly in different centers.MethodESRD patients diagnosed with SHPT in the First Affiliated Hospital,College of Medicine,Zhejiang University and confirmed to the surgical indications accepted PTX between November 2015 to December 2018 were enrolled in this retrospective study.Preoperative serum calcium,phosphate,alkaline phosphatase,and parathyroid hormone levels were collected,and were monitored and observed at 1 week,1 month,6 month and 1 year postoperatively.The clinic symptoms were inquired carefully pre-and post-PTX.After at least 1 year follow-up,we recorded and compared the Ca,P,PTH,ALP level post-operatively 1 week,1 moth,6 moth and 1year with pre-operation,and calculated the incidence of hypocalcemia post 1 moth of PTX and its related risk factor.And recorded the incidence of the survive rate of parathyroidism graft,and the Ca,P change within 1 year post-PTX,so as to the cumulative dosage of calcium carbonate and calcitriol post 1moth and 6 moth of PTX respectively.And analyzed the affective factors.ResultThere were 274 patients enrolled in this retrospective cohort,the serum calcium,phosphate,PTH of all the patients post 1 week,1moth,6 moth,1 year declined significantly compared to pre-PTX,P <0.05.The post 1week ALP was increased compared with pre-PTX,but declined significantly post 1moth,6 moth 1 year compared with pre-PTX,P<0.05.The incidence of hypocalcemia post 1moth of the surgery was 30.66%(<2.1mmol/l),while the severe hypocalcemia post 1moth of the surgery was 5.11%(<1.875mmol/l).By using multivariate logistic regression analysis,pre-operative serum P level(OR=2.045,95%CI:1.135-3.686 P=0.017)was the independent risk factor of hypocalcemia post 1moth of PTX and the cumulative dosage of calcitriol post 1moth of PTX(OR=0.971,95%CI:0.944-0.998 P=0.037)was the protective factor of hypocalcemia post 1moth of PTX.Male(OR=7.401,95%CI:1.359-40.303 P=0.021)and pre-operative serum P level(OR=4.222,95%CI:1.20-14.85 P=0.025)were the independent risk factor of severe hypocalcemia.Of all the 274 patients,there were 254 patients accepted TPTX+AT,among whom 191 patients successfully have all the parathyroidism cut.After 1 year follow-up,there were 154 patients’ grafts survived,and the survive rate of postoperative parathyroidism graft was 80.63%.The Ca,P post-PTX within 1 year and cumulative dosage of calcium carbonate calcitriol post-PTX 1 moth and 6moth respectively between grafts survive group and none grafts survive group didn’t exist difference.ConclusionPTX is an effective treatment of SHPT,the post-operative Ca,P,PTH,ALP can be improved significantly;The hypocalcemia is a common complication of PTX,high-preoperative serum P level is the independent risk factor of hypocalcemia post 1moth of PTX,and the cumulative dosage of calcitriol post 1moth of PTX was the protective factor of hypocalcemia post 1moth of PTX,and male and high-preoperative serum P level were the independent risk factor of severe hypocalcemia post 1moth of PTX.The graft survive rate of TPTX+AT in our center was 80.63%.The Ca,P post-PTX within 1 year and the difference of cumulative dosage of calcium carbonate and calcitriol post-PTX 1 moth and 6moth respectively between grafts survive group and none grafts survive group didn’t exist.