Renal transplantation
Complications
Effect of Parathyroidectomy on Renal Graft Function

https://doi.org/10.1016/j.transproceed.2005.02.009Get rights and content

Abstract

Some authors have reported acute impairment of renal transplant function after parathyroidectomy (PTx). Since 1996 PTx has been performed in 22 renal transplant recipients (follow-up, 24.2 ± 15 months; serum creatinine concentration (SCr) pre-PTx, 1.26 ± 0.4 mg/dL). We analyzed the serum levels of immunoreactive parathyroid hormone, calcitriol, calcium, phosphate, alkaline phosphatase, SCr, and hemoglobin, as well as proteinuria, blood pressure, and immunosuppressive treatment at several times: before PTx and at 7 days, 1 month, and then every 3 months post-PTx. After PTx we observed acute renal function deterioration until the third post-PTx month, when SCr levels returned to baseline values. We found no changes in blood pressure, although there was a trend toward a reduced dosage of antihypertensive drugs. We compared the patients who showed more significant increases (>30% from baseline) in SCr (group A, n = 7) with those who did not (group B, n = 15). Group A had higher SCr levels pre-PTx. We observed no other significant differences, either pre-PTx or post-PTx. In 2 patients in group A, SCr returned to baseline at the third month after PTx, but in the other 5 the renal function impairment persisted. Taking into account this risk and that severe hyperparathyroidism does not revert after transplantation, it would seem more appropriate in such cases to perform PTx while the patient is on the waiting list. The causes of this renal functional impairment are not clear, but the patients who showed worse deterioration also had a worse renal function pre-PTx.

Section snippets

Patients and methods

Since 1996 we have identified 22 renal transplant patients who required posttransplantation PTx to treat persistent hyperparathyroidism. All patients displayed hypercalcemia, and PTx was indicated after the first year posttransplantation. In all cases renal function was good and stable prior to PTx: serum creatinine concentration (SCr), 1.26 ± 0.4 mg/dL. The characteristics of the patients are shown in Table 1. The surgical procedure was total PTx with autotransplantation in the nondominant

Results

The outcome after PTx is shown in Table 2. Following PTx, a significant decrease was observed in iPTH levels. To date, none of the patients showed recurrence of hyperparathyroidism. Serum Ca levels decreased, and were kept at normal values by transient administration of Ca and active vitamin D. Blood pressure values were maintained, with no significant differences pre-PTx and post-PTx observed. However, we noticed a trend to require fewer antihypertensive drugs after PTx. The renal function

Discussion

Kidney transplantation does not usually revert to moderate to severe secondary hyperparathyroidism. Only 23% of recipient patients with good renal function (SCr <2 mg/dL) have normal iPTH levels 1 year after transplantation.1 Hyperparathyroidism can persist for several reasons, including incomplete recovery of renal function, presence of enlarged parathyroid glands with nodular hyperplasia, suboptimal posttransplantation levels of calcitriol, and decreased intestinal Ca absorption as a result

References (7)

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    Callender et al16 recently revealed that PTX before KTx decreased graft failure after transplantation. Furthermore, PTX after transplantation has been shown previously to compromise kidney graft function also regarding long-term outcome, while detailed analyses comparing early versus late post-transplant PTX have been lacking so far.11,17,18 Post-transplant PTX for persistent sHPT is associated with an increased risk of a decrease in kidney graft function after PTX, which has been suggested to be transient and likely to recover to pre-PTX graft function levels within 12 months after the operation.11

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