Renal transplantationComplicationsEffect of Parathyroidectomy on Renal Graft Function
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)
- et al.
Blood pressure reduction after parathyroidectomy for secondary hyperparathyroidism: further evidence implicating calcium homeostasis in blood pressure regulation
Am J Kidney Dis
(1996) - et al.
Calcium metabolism and skeletal problems after transplantation
J Am Soc Nephrol
(2002) - et al.
Management of disturbed calcium metabolism in uremic patients. 2. Indications for parathyroidectomy
Nephrol Dial Transplant
(2000)
Cited by (41)
Parathyroidectomy or cinacalcet: Do we still not know the best option for graft function in kidney-transplanted patients? A meta-analysis
2021, Surgery (United States)Citation Excerpt :This could explain the contradictory results in the published series, which led us to perform this meta-analysis. Indeed, since Rostaing et al first showed a significant decrease of graft function at 3 months postparathyroidectomy on 34 patients in 1997,58 numerous studies have reported alternately permanent11,20,47 or transitory13,24–26,48 worsening in kidney-transplant function with a mean follow-up between 3 months and 5 years. The same assessment applies with calcimimetics, which showed improvement,6 worsening,16 or no modification37–39,45 of kidney-transplant function.
Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy
2018, Surgery (United States)Citation Excerpt :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
Parathyroidectomy in Persistent Post-transplantation Hyperparathyroidism — Single-center Experience
2017, Transplantation ProceedingsCitation Excerpt :PTH exerts an important pre-glomerular vasodilatory as well as efferent vasoconstriction, as shown in animal models infused with PTH [16]. This finding of acute, albeit reversible, dysfunction has been reported by other authors [10,11], and is consistent with other studies which show a long-term normalization of kidney function [17] and no adverse graft outcomes associated with PTX [18]. The small sample size of our study is a limitation to access the effect of PTX on graft survival.
Does the Parathyroidectomy Endanger the Transplanted Kidney?
2016, Transplantation ProceedingsExploring the effect of parathyroidectomy for tertiary hyperparathyroidism after kidney transplantation
2010, American Journal of the Medical Sciences