Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy

Littbarski, Simon A.; Kaltenborn, Alexander; Gwiasda, Jill; Beneke, Jan; Arelin, Viktor; Schwager, Ysabell; Stupak, Julia; Marcheel, Indra Louisa; Emmanouilidis, Nikos; Jäger, Mark D.; Scheumann, G. F. W.; Klempnauer, Jürgen; Schrem, Harald

doi:10.1016/j.surg.2017.10.016

Cited by 35 publications

(34 citation statements)

References 19 publications

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“…After parathyroidectomy, a uniform and significant decrease in eGFR by 25% was observed. This loss of eGFR is greater than reported in other studies showing a 10% decline in eGFR [16,19]. The course of renal function after the initial loss of eGFR is unknown.…”

Section: Discussioncontrasting

confidence: 53%

“…The adverse short-term effect of parathyroidectomy on renal graft function is well-known [15,16,19]. We were interested in the longterm graft function of patients with parathyroidectomy and the factors that determine this outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, it is not possible to predict which patient will suffer from a temporary or persistent decline in graft function after parathyroidectomy. To this end, (i) a greater iPTH drop (ii) lower serum calcium, (iii) and requirement for more intense substitution with calcium and vitamin D analogues for hypocalcemia after parathyroidectomy, (iv) lower baseline creatinine before parathyroidectomy, (v) and the time interval between parathyroidectomy and transplantation have been inconsistently reported as potential factors of a declining renal function after parathyroidectomy [3,15,18,19]. Furthermore, the effects of different extents of parathyroid tissue resection on the graft function are still under discussion [15,19,20].…”

Section: Introductionmentioning

confidence: 99%

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Long-term renal graft outcome after parathyroidectomy - a retrospective single centre study

et al. 2020

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Background: Surgical correction of hyperparathyroidism after kidney transplantation has been associated with significant graft function decline. We examined the effects of parathyroidectomy on short-and long-term graft function and its potential predictors. Methods: For this retrospective, monocentric study we identified 48 (5.5%) out of 892 patients from our protocol biopsy program who received renal transplantation between 2000 and 2007, with parathyroidectomy after transplantation. Data from up to three years after parathyroidectomy was collected and analyzed with multivariable linear regression analyses. Results: Main indications for parathyroidectomy were hypercalcemia and graft calcifications. Parathyroidectomy was successful in 47 patients, with a median drop in serum intact parathormone (iPTH) from 394 to 21 pg/ml. Mean estimated glomerular fitration rate (eGFR) before parathyroidectomy was 60 ± 26 ml/min. At three months after parathyroidectomy, the eGFR was 46 ± 18 ml/min (p < 0.001) but remained stable at one and three years (50 ± 20; 49 ± 20 ml/min). The median annual eGFR change was − 0.5 ml/min before and + 1.0 ml/min after parathyroidectomy. Multivariable modeling identified high iPTH levels and higher eGFR before parathyroidectomy as predictors of the eGFR drop after parathyroidectomy. Lower graft function twelve months after parathyroidectomy was predicted by the eGFR before and the iPTH drop after surgery. Conclusions: These results indicate that the extent of parathyroidectomy is critical and too much lowering of iPTH should be avoided by timely parathyroidectomy, before reaching extreme high iPTH values. In view of the observed loss of eGFR, parathyroidectomy can be considered safe in patients with an eGFR above 30 ml/min.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-term renal graft outcome after parathyroidectomy - a retrospective single centre study

et al. 2020

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“…Parikh et al also reported a significant but transient decline in eGFR post-PTx [16]. Another recent study by Littbarski et al [22] suggested that, particularly early (\1 year) after transplantation, PTx contributes to renal function loss. Despite the larger sample size in our study We found that pre-PTx PTH levels were significantly lower in the group of patients who underwent PTx after KTx.…”

Section: Discussionmentioning

confidence: 96%

Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation

et al. 2019

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Background Parathyroidectomy (PTx) is the treatment of choice for end-stage renal disease (ESRD) patients with therapy-resistant hyperparathyroidism (HPT). The optimal timing of PTx for ESRD-related HPT-before or after kidney transplantation (KTx)-is subject of debate. Methods Patients with ESRD-related HPT who underwent both PTx and KTx between 1994 and 2015 were included in a multicenter retrospective study in four university hospitals. Two groups were formed according to treatment sequence: PTx before KTx (PTxKTx) and PTx after KTx (KTxPTx). Primary endpoint was renal function (eGFR, CKD-EPI) between both groups at several time points post-transplantation. Correlation between the timing of PTx and KTx and the course of eGFR was assessed using generalized estimating equations (GEE). Results The PTxKTx group consisted of 102 (55.1%) and the KTxPTx group of 83 (44.9%) patients. Recipient age, donor type, PTx type, and pre-KTx PTH levels were significantly different between groups. At 5 years after transplantation, eGFR was similar in the PTxKTx group (eGFR 44.5 ± 4.0 ml/min/1.73 m 2) and KTxPTx group (40.0 ± 6.4 ml/min/1.73 m 2 , p = 0.43). The unadjusted GEE model showed that timing of PTx was not correlated with graft function over time (mean difference-1.0 ml/min/1.73 m 2 , 95% confidence interval-8.4 to 6.4, p = 0.79). Adjustment for potential confounders including recipient age and sex, various donor characteristics, PTx type, and PTH levels did not materially influence the results. Conclusions In this multicenter cohort study, timing of PTx before or after KTx does not independently impact graft function over time.

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“…Few studies suggested that post-transplant PTX is inferior to pretransplant PTX in terms of renal allograft function preservation. [44][45][46] A possible etiology is that renal impairment caused by prolonged hy-…”

Section: Discussionmentioning

confidence: 99%

Early persistent hyperparathyroidism post‐renal transplantation as a predictor of worse graft function and mortality after transplantation

Isakov

Ghinea

Beckerman

et al. 2020

Clinical Transplantation

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pHPT has been reported in up to 80% of renal transplant recipients (RTR) during the first year after kidney transplantation. 1 There is marked variation in the reported prevalence related mainly to differences in diagnostic criteria and absence of a clear definition to post-renal transplantation pHPT. Inappropriately high PTH levels post-transplant contribute to post-transplant complications such as hypercalcemia, hypophosphatemia, elevated fibroblast growth factor 23 (FGF-23), and nephrocalcinosis. 2,3 Studies showed an association between PTH and risk of hypertension (HTN), left ventricular hypertrophy, heart failure, coronary artery disease, and mortality. 4-8 While the association between pretransplant CKD-mineral bone density (MBD) markers and

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Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy

Cited by 35 publications

References 19 publications

Long-term renal graft outcome after parathyroidectomy - a retrospective single centre study

Long-term renal graft outcome after parathyroidectomy - a retrospective single centre study

Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation

Early persistent hyperparathyroidism post‐renal transplantation as a predictor of worse graft function and mortality after transplantation

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