Objective:

To evaluate the safety and medium-term efficacy of clean parathyroidectomy with autotransplantation (CPTX+AT) for managing refractory secondary hyperparathyroidism (SHPT).

Approach:

• Study Design: A retrospective cohort study comparing 98 patients undergoing CPTX+AT with 80 patients undergoing total parathyroidectomy with autotransplantation (TPTX+AT).
• Inclusion Criteria: Patients with uncontrolled SHPT excluded from kidney transplantation waiting lists.
• Outcome Measures: Perioperative outcomes, biochemical parameters, clinical symptom resolution, complications, recurrence rates, and patient-centered hard outcomes were analyzed.
• Surgical Strategy: Intraoperative parathyroid hormone (ioPTH) measurement was used to optimize surgical strategy.

Key Findings:

• Postoperative biochemical parameters improved significantly in the CPTX+AT group (p < 0.001).
• Complete resolution of clinical symptoms was achieved by 3 months postoperatively in the CPTX+AT group (p < 0.001).
• No recurrence was detected in the CPTX+AT group during a median follow-up of 25 months (0/98).
• The recurrence rate in the TPTX+AT group was 5.0% (4/80) during a median follow-up of 47 months (p = 0.026).
• Complication rates were comparable between the two groups (12.24% in the CPTX+AT group vs. 12.50% in the TPTX+AT group, p > 0.05).

Interpretation:

CPTX+AT is a safe and effective medium-term strategy for uncontrolled SHPT in non-kidney transplantation candidates, achieving durable biochemical and symptomatic improvement based on the study results.

Limitations:

• The retrospective design may introduce bias, affecting the reliability of the findings.
• The follow-up duration was shorter in the CPTX+AT group compared to the TPTX+AT group, which may limit the assessment of long-term outcomes.

Conclusion:

CPTX+AT is an effective approach for managing uncontrolled SHPT, particularly for patients at high risk of recurrence due to ectopic parathyroid tissue.