Total Parathyroidectomy and Forearm Autotransplantation for Chronic Renal Failure

We reviewed 12 cases of chronic renal failure in patients with secondary hyperparathyroidism who had total parathyroidectomy and forearm autotransplantation during the years 1978 to 1984. All had elevated parathyroid hormone and calcium levels before the procedure. Using a technique previously described, with relatively large parathyroid grafts in the forearm, calcium levels were effectively reduced and maintained below the upper limit of the normal range (10.5 mg/dl). Only one patient had symptomatic hypocalcemia postoperatively. Phosphorous levels were also significantly reduced to more physiologic values. When necessary, the forearm autografts allowed simplified titration of calcium levels on an outpatient basis.