Parathyroidectomy after kidney transplantation: short- and long-term impact on renal function

Abstract

INTRODUCTION:Kidney transplantation corrects endocrine imbalances. Nevertheless, these early favorable events are not always followed by rapid normalization of parathyroid hormone secretion. A possible deleterious effect of parathyroidectomy on kidney transplant function has been reported. This study aimed to compare acute and long-term renal changes after total parathyroidectomy with those occurring after general surgery.MATERIALS AND METHODS:This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations.RESULTS:In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL).CONCLUSION:Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up.

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

“…Significant increase of serum creatinine from 7 to 35 % following PTX in patients with tertiary HPT occurs mainly in the early postoperative phase, while long-term follow-up revealed stabilization of renal function within 12 months post-PTX without significant differences compared to post-renal transplantation patients not submitted to PTX [128][129][130] (EL 2). The degree of early postoperative renal impairment represented by increase of GFR was in tendency prone to be higher in TPTX+AT compared to subtotal PTX [129], and a more pronounced decrease of GFR post-PTX was associated with higher preoperative PTH [130] (EL 2b).…”

“…Also, post-transplantation PTX exposes to a risk of declining renal function due to immediate haemodynamic effect of PTH level drop [128][129][130] (EL 2) and to hypercalciuria secondary to medical treatments of hypocalcaemia. Patients should be operated after efficient vitamin D supplementation in order to avoid severe postoperative hypocalcaemia [115] (EL 3).…”

“…However, hypercalcemia before PTX may prevent vitamin D supplementation in some. Patients with higher pre-PTX PTH levels will experience the greatest PTH decline any may experience greater decrease of renal function [128][129][130] (EL 3). Severe persistent renal HPT is associated with hypercalciuria.…”

Kidney transplantation and hyperparathyroidism

“…До недавнего време-ни основным способом лечения третичного ГПТ у реципиентов почечных трансплантатов и во взрослой, и в детской популяции было хирурги-ческое пособие -ПТЭ. Многолетний опыт пока-зывает, что потребность реципиентов донорских почек в ПТЭ колеблется от 0,5% до нескольких процентов [11,[29][30][31][32]. В ближайшем будущем…”

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

“…Para os transplantados renais, a PTx é realizada entre 0,6% a 32% dos casos (5,37). Trabalho realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC--FMUSP) mostrou porcentagem de 3,1% (15).…”