Effect of Parathyroidectomy on Renal Graft Function

García, A. Delgado; Mazuecos, Auxiliadora; García, Teresa Martín; González, P.; Ceballos, M; Rivero, M.

doi:10.1016/j.transproceed.2005.02.009

Cited by 40 publications

(24 citation statements)

References 5 publications

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“…Thus, they explained this transient deterioration of kidney function by the reversal of the hemodynamic effects of PTH as it exerts a significant afferent vasodilatory as well as efferent vasoconstrictory effects [19]. This finding has also been reported by others, but their results pointed to the long-term stability of the kidney function [20-23]. …”

Section: Discussionsupporting

confidence: 52%

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

El-Husseini

Wang

Edon

et al. 2017

Nephron

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Background: In dialysis and renal transplant patients with secondary and tertiary hyperparathyroidism (HPT), the value of intraoperative parathyroid hormone (ioPTH) during parathyroidectomy (PTX) and its association with long-term PTH levels are unknown. The present study aims at evaluating the relationship of ioPTH with long-term PTH levels post-PTX in dialysis and renal transplant patients in a single-center study. Methods: The ioPTH was measured in 57 dialysis patients (33 females and 24 males) and 18 renal transplant recipients (12 males and 6 females) who underwent PTX from 2005 to 2015 for refractory HPT. Near-total PTX was performed in 56 patients and total PTX with autotransplantation in 20 patients. The PTH monitoring included 3 samples: pre-intubation, 10- and 20-min (pre-ioPTH, 10-ioPTH, and 20-ioPTH) post parathyroid gland excision. Patients were followed up for up to 5 years. Results: In the dialysis group, the median (25th–75th percentile) pre-, 10-, and 20-ioPTH levels were 1,447 pg/mL (938–2,176), 143 pg/mL (78–244) and 112 pg/mL (59–153) respectively. In the renal transplant group, pre-, 10-, and 20-ioPTH levels were 273 pg/mL (180–403), 42 pg/mL (25–72), and 34 pg/mL (23–45) respectively. All patients in the transplant group had a functional kidney transplant at the time of PTX with a median serum creatinine of 1.3 mg/dL (1.2–1.7) and estimated glomerular filtration rate of 55 mL/min (40–60). The median time between renal transplant and PTX surgeries was 22 months (7–81). The last median follow-up PTH level was 66 pg/mL (15–201) in the dialysis group and 54 pg/mL (17–72) in the transplant group (p = 0.438). The mean time for last PTH post-PTX was 2.3 ± 2.0 years. In both groups, there was no significant difference between 20-ioPTH and any-time post-PTX PTH levels (p = 0.6 and p = 0.9). Nineteen patients (25%) were readmitted within 90 days because of hypocalcemia. One patient in the dialysis group was readmitted for post-PTX hematoma evacuation. No patient required repeat PTX because of recurrent HPT that was refractory to medical therapy. Only one dialysis patient required repeat PTX because the first procedure failed. Conclusions: The 20-ioPTH is a good indicator of long-term PTH levels in dialysis and renal transplant patients. Hypocalcemia is a common complication, particularly in dialysis patients, and it is the main reason for readmission after PTX. Hypoparathyroidism is a potential concern after PTX in dialysis patients.

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Section: Discussionsupporting

confidence: 52%

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

El-Husseini

Wang

Edon

et al. 2017

Nephron

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“…These treatments included parathyroidectomy, vitamin D, and cinacalcet hydrochloride [47,48,49,50,51,52,53,54,55,56,57,58]. In general, while these treatments were associated with some improvement in laboratory values, the lack of control groups makes inferences about efficacy difficult.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Bone and Mineral Metabolism in Kidney Transplant Patients – A Review

et al. 2007

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Background/Aims: Abnormal bone and mineral metabolism is common in patients with kidney failure and often persists after successful kidney transplant. Methods: To better understand the natural history of this disease in transplant patients, we reviewed the literature by searching MEDLINE for English language articles published between January 1990 and October 2006 that contained Medical Subject Headings and key words related to secondary or persistent hyperparathyroidism and kidney transplant. Results: Parathyroid hormone levels decreased significantly during the first 3 months after transplant but typically stabilized at elevated values after 1 year. Calcium tended to increase after transplant and then stabilize at the higher end of the normal range within 2 months. Phosphorus decreased rapidly to within or below normal levels after surgery and hypophosphatemia, if present, resolved within 2 months. Low levels of 1,25(OH)₂ vitamin D typically did not reach normal values until almost 18 months after transplant. Conclusion: This review provides evidence demonstrating that abnormal bone and mineral metabolism exists in patients after kidney transplant and suggests the need for treatment of this condition. However, better observational and interventional research is needed before advocating such a treatment guideline.

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“…Lee et al [22] described a negative effect of subtotal PTX on graft function in 22 patients after kidney transplantation. Garcia et al [29] reported persistent impairment of renal function after PTX in patients who already had preoperative elevation of s-creatinine-levels. In this study, level of iPTH and serum calcium in all patients who underwent successful PTXs stayed within normal range after PTX during a median follow-up period of 54 months (range 23~142), and there was no PTX-related deterioration of kidney graft function.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

et al. 2011

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TerTiary hyperparathyroidism (tHPT) can develop after any long-standing period of hypocalcemia, such as those seen with chronic dialysis or gastrointestinal malabsorption; however, tHPT occurs most commonly in the setting of kidney transplantation (KTX), whereby patients with secondary HPT continue to have elevated parathyroid hormone (PTH) levels after KTX. tHPT has been reported in up to 50% of patients who underwent KTX [1, 2] and its occurrence is thought to be related to severity of pretransplant HPT [3] and duration of dialysis prior to transplantation [1,4,5]. Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient method for treatment of tHPT. In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery. Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5%) were identified as having tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function. One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX. We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs. Levels of iPTH and serum calcium were at normal range after PTX. Estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function. We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.

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Effect of Parathyroidectomy on Renal Graft Function

Cited by 40 publications

References 5 publications

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

Value of Intraoperative Parathyroid Hormone Assay during Parathyroidectomy in Dialysis and Renal Transplant Patients with Secondary and Tertiary Hyperparathyroidism

Abnormal Bone and Mineral Metabolism in Kidney Transplant Patients – A Review

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

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