Tertiary hyperparathyroidism (tHPT) usually regresses after renal transplantation. Persistent tHPT after successful renal transplantation may require parathyroidectomy (PTX). PTX has been reported to be associated with deterioration of renal function and graft survival. We retrospectively analyzed 794 kidney transplants performed at our center with at least 3 years of follow-up to examine the effect of PTX on the renal function and graft survival. Forty-nine of the 794 renal transplant recipients were diagnosed with hyperparathyroidism (HPT) before transplant. Nineteen of 49 patients had persistent tHPT and underwent PTX after kidney transplants. Patients with HPT and non-HPT had similar 3-year graft survival (88% versus 84%, P = 0.51). PTX was associated with a decreased glomerular filtration rate at 3 years (44.7 ± 20.0 versus 57.7 ± 23.7 mL/min, P = 0.04); however, there was no statistical difference in the 3-year graft survival (71% versus 88%, P = 0.06). PTX in renal transplant recipients seems to be a safe and effective therapy for persistent tHPT. PTX may be associated with worsening glomerular filtration rate, but it may not be associated with significantly decreased longterm graft survival. Key Indexing TermsHyperparathyroidism; Parathyroidectomy; Kidney transplant; Graft function; Graft survival Nowadays, the term tertiary hyperparathyroidism (tHPT) is used almost exclusively in the context of persistent hyperparathyroidism (HPT) after successful renal transplantation. Development of tHPT is multifactorial, although phosphate retention and loss of renal 1-hydroxylase activity with low 1,25-(OH) 2 vitamin D 3 level are the principal factors. 1 For hyperparathyroidism in patients with end-stage renal disease, the currently accepted practice for management is initially medical therapy with parathyroidectomy (PTX) reserved for refractory disease. 2 The incidence of tHPT is reported in up to 50% of patients who undergo kidney transplantation,3 and its occurrence is thought to be related to the duration of dialysis before transplantation.3 , 4 Although tHPT has been recognized for a long time, the management of the disease is still controversial. Currently, guidelines for referral of these patients for surgery do not exist. Hypercalcemia usually gradually resolves within the first year after successful kidney transplantation. 4 Therefore, patients with persistent hypercalcemia should be considered for PTX, which includes subtotal or total PTX with auto-transplantation. Indications NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript for surgical intervention include persistent hypercalcemia, symptomatic tHPT, or deterioration of kidney function associated with tHPT. 4 Although it was previously reported that patients with functioning kidney grafts had unaffected renal function after PTX, there are recent reports that PTX might seriously endanger the long-term graft survival. [5][6][7] The purpose of this study was to examine our 10-year experience with patients with end-stage re...

Background Living donor kidneys with multiple arteries (MA) are increasingly procured laparoscopically for transplant. Methods We compare long-term graft function and survival of kidneys with single arteries (SA) and MA over a 10-year period. Results There were a total of 218 grafts with SA and 60 grafts with MA. The MA group had longer operative and ischemic times than SA group. There was a small increase in ureteral complication (8.3% vs. 2.3% P=0.06) and a significantly higher incidence of rejection (23.3% vs. 10.1%, P=0.01) in MA group than in SA group. Graft function was lower in MA group than SA group. The 5-year graft survival by Kaplan Meier analysis was better in SA group than in MA group (P=0.023). The estimated graft survivals at 1, 3, and 5 year were 94.4%, 90.6%, and 86% for SA group and 89.6%, 83.2%, and 71.8% for MA group. There was a higher percentage of graft loss from chronic allograft nephropathy in MA group than in SA group (16.7% vs. 5.5%, P=0.01). The presence of MA (vs. SA) was an independent risk for acute rejection (OR 3.60, 95% CI 1.59–8.14, P=0.002) and for graft loss (HR 2.31, 95% CI 1.05–5.09, P=0.038). Conclusion Laparoscopic procurement of living donor kidneys with SA may be associated with a lower risk of rejection, better function, and superior long-term survival when compared with kidneys with MA.

Background and objectives: The optimal donor age for transplanting a single pediatric kidney in an adult recipient remains unknown. En block kidney transplantation is usually performed when the donor age is <5 yr.Design, setting, participants, & measurements: We compared the outcomes of adult patients who underwent transplantation with single pediatric kidneys from donors who were younger than 5 yr (group 1, n ‫؍‬ 40) and from donors who were aged 5 to 10 yr of age (group 2, n ‫؍‬ 39) in our center.Results: The donor kidney sizes were significantly smaller in group 1 than in group 2 (P < 0.001), and group 1 required more ureteral stents than group 2 (73 versus 38%). The surgical complications, delayed graft function, and development of proteinuria were similar in both groups. Group 1 had slightly higher rejection episodes than group 2 (25 versus 18%; P ‫؍‬ 0.67), and graft function was comparable in both groups. There were no statistical differences between the two groups in patient (P ‫؍‬ 0.73) or death-censored graft (P ‫؍‬ 0.68) survivals over 5 yr.Conclusions: Single pediatric kidney transplants from donors who are younger than 5 yr can be used with acceptable complications and long-term outcomes as those from older donors.

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