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World Journal of Surgery
Published in: World Journal of Surgery 2/2020

01-02-2020 | Hyperparathyroidism | Original Scientific Report

Comparison of Pre- and Post-transplant Parathyroidectomy in Renal Transplant Recipients and the Impact of Parathyroidectomy Timing on Calcium Metabolism and Renal Allograft Function: A Retrospective Single-Center Analysis

Authors: Manabu Okada, Takahisa Hiramitsu, Toshihiro Ichimori, Norihiko Goto, Shunji Narumi, Yoshihiko Watarai, Tetsuhiko Sato, Yoshihiro Tominaga

Published in: World Journal of Surgery | Issue 2/2020

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Abstract

Background

The effect of parathyroidectomy (PTx) timing on serum calcium (Ca) levels and renal functions in renal transplant recipients with severe hyperparathyroidism (HPT) remains unclear. We retrospectively aimed to investigate and compare the clinical data of patients who underwent pre- and post-transplant PTx and elucidated the impact of PTx timing on serum Ca levels and renal graft outcomes after renal transplantation (RTx).

Methods

During January 2000–December 2016, 53 and 55 patients underwent post-transplant PTx (Post-RTx group) and pretransplant PTx (Pre-RTx group), respectively. The serum Ca levels and estimated glomerular filtration rate (eGFR) were assessed in both groups.

Results

At the end of the follow-up, the serum Ca levels were significantly higher and the incidence of hypocalcemia was significantly lower in the Pre-RTx group than in the Post-RTx group [9.5 vs. 8.9 mg/dL, P < 0.001; 14.5% vs. 34.0%, P = 0.024]. The decrease in the eGFR 12–36 months after RTx was more significant in the Post-RTx group than in the Pre-RTx group (−13.8% vs. −0.9%; P = 0.001). A logistic regression involving age, sex, dialysis period, and serum parathormone level revealed that post-transplant PTx is an independent risk factor for persistent hypocalcemia at the end of the follow-up (P = 0.034) and for a >20% decrease in the eGFR 12–36 months after RTx (P = 0.029).

Conclusions

In renal transplant candidates with severe HPT, pretransplant PTx should be considered to prevent persistent hypocalcemia and deterioration of the renal graft function.
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Metadata
Title
Comparison of Pre- and Post-transplant Parathyroidectomy in Renal Transplant Recipients and the Impact of Parathyroidectomy Timing on Calcium Metabolism and Renal Allograft Function: A Retrospective Single-Center Analysis
Authors
Manabu Okada
Takahisa Hiramitsu
Toshihiro Ichimori
Norihiko Goto
Shunji Narumi
Yoshihiko Watarai
Tetsuhiko Sato
Yoshihiro Tominaga
Publication date
01-02-2020
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 2/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05124-6

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