Résultats de la parathyroïdectomie subtotale de principe associée à une thymectomie systématique pour le traitement de l'hyperparathyroïdisme tertiaire après transplantation rénale chez 70 patients

Triponez, Frédéric; Dosseh, David; Hazzan, Marc; Noël, Christian; Vanhille, P.; Fleury, D.; Lemaı̂tre, V.; Wambergue, François; Tacquet, A; Proye, C

doi:10.1016/j.anchir.2005.12.007

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…[2]. However following successful renal transplantation, as GFR normalizes, spontaneous resolution occurs in the majority [24,5,15]. This is mainly dependent on the degree of parathyroid gland hyperplasia and its ability to involute post renal transplantation [16].…”

Section: Discussionmentioning

confidence: 99%

“…Persistent hyperparathyroidism worsens hypercalcemia and induces hypophosphatemia which can result in acute tubular necrosis in the renal allograft [19][20][21][22]. Tertiary HPT in particular may also lead to hypertension and hypercalciuria with kidney stones, especially problematic for the graft [23,24]. More importantly, their management is controversial [2] since PTX itself can lead to allograft dysfunction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Experience with Post Transplant Parathyroidectomy in Gulf Region and Literature Review

Abouchacra¹,

Chaaban²,

Baki³

et al. 2013

OJNeph

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Sustained elevation of parathyroid hormone (PTH) levels is not uncommon post renal transplantation. Though in the majority of patients, it gradually normalizes, on average 5% of transplanted patients require parathyroidectomy (PTX). However, PTX itself has been associated with deterioration in allograft function and even completes graft loss seen with both total and subtotal PTX as well as an increased rate of acute rejection. The aim of this study was to determine the effect of post transplant partial PTX on allograft function in our patients as well as the incidence of acute rejection. Our results show that post transplantation, subtotal PTX, was successful in achieving metabolic control while preserving graft function without an increased incidence of acute rejection. Retention of sufficient residual parathyroid tissue with partial PTX might account for favorable outcome in our study. Despite this, surgery for advanced hyperparathyroidism should optimally take place in the pre-transplant period.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Experience with Post Transplant Parathyroidectomy in Gulf Region and Literature Review

Abouchacra¹,

Chaaban²,

Baki³

et al. 2013

OJNeph

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Surgical Treatment of Tertiary Hyperparathyroidism: The Choice of Procedure Matters!

et al. 2007

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PTX is an efficient way to treat tHPT but represents a risk for impairing graft function, especially for patients that already demonstrate poor kidney function at the time of surgery. In the aim to prevent transient hypoparathyroidism, which may provoke reduced graft perfusion, as one possible cause of kidney graft deterioration associated with PTX, one should consider subtotal instead of total parathyroidectomy.

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Exploring the Effect of Parathyroidectomy for Tertiary Hyperparathyroidism After Kidney Transplantation

Kandil

Florman

Alabbas

et al. 2010

The American Journal of the Medical Sciences

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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...

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Résultats de la parathyroïdectomie subtotale de principe associée à une thymectomie systématique pour le traitement de l'hyperparathyroïdisme tertiaire après transplantation rénale chez 70 patients

Cited by 5 publications

References 25 publications

Experience with Post Transplant Parathyroidectomy in Gulf Region and Literature Review

Experience with Post Transplant Parathyroidectomy in Gulf Region and Literature Review

Surgical Treatment of Tertiary Hyperparathyroidism: The Choice of Procedure Matters!

Exploring the Effect of Parathyroidectomy for Tertiary Hyperparathyroidism After Kidney Transplantation

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