Parathyroidectomy versus Cinacalcet in the Management of Tertiary Hyperparathyroidism: Surgery Improves Renal Transplant Allograft Survival

Finnerty, Brendan M.; Chan, Tyler W.; Jones, Gregory D.; Khader, Tarek; Moore, Michal C.; Gray, Katherine D.; Beninato, Toni; Watkins, Anthony C.; Zarnegar, Rasa; Fahey, Thomas J.

doi:10.1016/j.surg.2018.04.090

Cited by 40 publications

(23 citation statements)

References 22 publications

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“…One study reported that the diameter of the parathyroid gland is a main factor involved in resistance to Cinacalcet [13]. Parathyroidectomy for tertiary hyperparathyroidism is associated with lesser rates of renal allograft failure in cinacalcet management [14].…”

Section: Discussionmentioning

confidence: 99%

Recurrent tertiary hyperparathyroidism due to supernumerary parathyroid glands in a patient receiving long-term hemodialysis: a case report

et al. 2019

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BackgroundRenal hyperparathyroidism is a common complication of chronic kidney disease (CKD) or end-stage renal disease (ESRD) characterized by elevated parathyroid hormone levels secondary to derangements in the homeostasis of calcium, phosphate, and vitamin D. Rapid correction of severe and prolonged hyperparathyroidism by surgical parathyroidectomy in long-term hemodialysis patients occasionally causes hungry bone syndrome. These patients then exhibit severe and long-lasting secondary or tertiary hyperparathyroidism with high bone turnover.Case presentationWe report a case of recurrent tertiary hyperparathyroidism after total parathyroidectomy due to supernumerary parathyroid gland in a patient with long-term hemodialysis. Supplementation with intravenous calcium, oral calcium, and vitamin D immediately after patient surgery helps to prevent and treat hungry bone syndrome.ConclusionsWe should prompt a search for the supernumerary parathyroid glands in ESRD patients, who have recurrent or persistent hyperparathyroidism after total parathyroidectomy. ESRD patients are more likely to develop hungry bone syndrome after parathyroidectomy. Prevention and treatment of hungry bone syndrome may be required after ectopic parathyroidectomy in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Recurrent tertiary hyperparathyroidism due to supernumerary parathyroid glands in a patient receiving long-term hemodialysis: a case report

et al. 2019

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“…Nevertheless, there is also evidence to support a preference for PTX over the use of cinacalcet. In patients with tertiary hyperparathyroidism after KTx, cinacalcet can normalize the serum calcium levels, but unlike PTX, it cannot normalize the PTH levels [26,27]. However, there is no consensus on which PTH value clearly defines post-transplant HPT [28], but PTH levels were found to be an important negative independent predictor of MBD, intriguingly more deleterious than the cumulative dose of corticosteroids or inflammation [5].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial

Jehn

Kortenhorn

Schütte‐Nütgen

et al. 2022

JCM

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Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n = 47), only one (2.2%) patient had previously undergone PTX. After adjusting for the known fracture risk factors MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018–0.991, p = 0.049). We observed a reduced risk for pathological fractures in KTx patients who underwent PTX, independent from elevated parathyroid hormone at the time of KTx or afterwards.

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“…Finnerty et al also demonstrated that performing parathyroidectomy for persistent HPT was associated with improved renal allograft function as compared with cinacalcet [ 18 ]. However, in patients managed medically with cinacalcet alone, renal allograft failure was associated with increased PTH within 12 months posttransplant compared with patients with a functioning allograft (348 pg/mL vs. 195 pg/mL) [ 18 ]. Median PTH level in our subject (who did not receive parathyroidectomy) at 12-month posttransplant was 165 pg/mL (IQR 140), with 11 patients receiving calcimimetic and 63 patients not.…”

Section: Discussionmentioning

confidence: 99%

“…International Journal of Endocrinology Pihlstrøm et al found that PTH above the upper limit of normal indicated 85% higher risk of graft loss compared with low/normal values [6]. Finnerty et al also demonstrated that performing parathyroidectomy for persistent HPT was associated with improved renal allograft function as compared with cinacalcet [18]. However, in patients managed medically with cinacalcet alone, renal allograft failure was associated with increased PTH within 12 months posttransplant compared with patients with a functioning allograft (348 pg/mL vs. 195 pg/mL) [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Pretransplant Use of Calcimimetic on Parathyroid Function after Renal Transplantation

Bokuda

Morimoto

Seki

et al. 2021

International Journal of Endocrinology

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Objective. Persistence of hyperparathyroidism (HPT) after renal transplantation leads to undesirable outcomes such as increase in cardiovascular events, graft dysfunction, and increased mortality. Options for therapy include medical management with calcimimetic or operative management. The present study was undertaken to evaluate the natural history of HPT after renal transplantation and to determine risk factors for persistent HPT in the era of calcimimetic. Design. The study is a retrospective review of data from 74 consecutive patients who underwent renal transplantation at our institution from April 2011 to November 2019. Methods. The natural history of HPT after renal transplantation and associations between intact parathyroid hormone (PTH) level after transplantation and clinical variables such as age, sex, duration of pretransplant dialysis, and use of calcimimetic before transplantation were evaluated. Results. Intact PTH decreased after renal transplantation in most of the patients without receiving parathyroidectomy. Known risk factors of persistent HPT did not associate with intact PTH level after renal transplantation in patients who had been receiving calcimimetic before transplantation. Conclusion. In conclusion, we have found that HPT after renal transplantation could be managed successfully by medical treatments. When predicting the prognosis of HPT after transplantation, pretransplant use of calcimimetic should be taken into consideration.

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Parathyroidectomy versus Cinacalcet in the Management of Tertiary Hyperparathyroidism: Surgery Improves Renal Transplant Allograft Survival

Cited by 40 publications

References 22 publications

Recurrent tertiary hyperparathyroidism due to supernumerary parathyroid glands in a patient receiving long-term hemodialysis: a case report

Recurrent tertiary hyperparathyroidism due to supernumerary parathyroid glands in a patient receiving long-term hemodialysis: a case report

The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial

Effect of Pretransplant Use of Calcimimetic on Parathyroid Function after Renal Transplantation

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