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Open Access 01-02-2019 | Kidney Transplantation | Original Article

Parathyroidectomy versus cinacalcet for tertiary hyperparathyroidism; a retrospective analysis

Authors: R. R. Dulfer, E. Y. Koh, W. Y. van der Plas, A. F. Engelsman, E. J. M. Nieveen van Dijkum, R. A. Pol, L. Vogt, M. H. de Borst, S. Kruijff, A. Schepers, N. M. Appelman-Dijkstra, J. I. Rotmans, D. A. Hesselink, C. H. J. van Eijck, E. J. Hoorn, T. M. van Ginhoven, on behalf of the Dutch Hyperparathyroid Study Group

Published in: Langenbeck's Archives of Surgery | Issue 1/2019

Abstract

Introduction

Tertiary hyperparathyroidism (tHPT), i.e., persistent HPT after kidney transplantation, affects 17–50% of transplant recipients. Treatment of tHPT is mandatory since persistently elevated PTH concentrations after KTx increase the risk of renal allograft dysfunction and osteoporosis. The introduction of cinacalcet in 2004 seemed to offer a medical treatment alternative to parathyroidectomy (PTx). However, the optimal management of tHPT remains unclear.

Methods

A retrospective analysis was performed on patients receiving a kidney transplantation (KT) in two academic centers in the Netherlands. Thirty patients undergoing PTx within 3 years of transplantation and 64 patients treated with cinacalcet 1 year after transplantation for tHPT were included. Primary outcomes were serum calcium and PTH concentrations 1 year after KT and after PTx.

Results

Serum calcium normalized in both the cinacalcet and the PTx patients. PTH concentrations remained above the upper limit of normal (median 22.0 pmol/L) 1 year after KT, but returned to within the normal range in the PTx group (median 3.7 pmol/L). Side effects of cinacalcet were difficult to assess; minor complications occurred in three patients. Re-exploration due to persistent tHPT was performed in three (10%) patients.

Conclusion

In patients with tHPT, cinacalcet normalizes serum calcium, but does not lead to a normalization of serum PTH concentrations. In contrast, PTx leads to a normalization of both serum calcium and PTH concentrations. These findings suggest that PTx is the treatment of choice for tHPT.

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Title: Parathyroidectomy versus cinacalcet for tertiary hyperparathyroidism; a retrospective analysis
Authors: R. R. Dulfer
E. Y. Koh
W. Y. van der Plas
A. F. Engelsman
E. J. M. Nieveen van Dijkum
R. A. Pol
L. Vogt
M. H. de Borst
S. Kruijff
A. Schepers
N. M. Appelman-Dijkstra
J. I. Rotmans
D. A. Hesselink
C. H. J. van Eijck
E. J. Hoorn
T. M. van Ginhoven
on behalf of the Dutch Hyperparathyroid Study Group
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Keywords: Kidney Transplantation
Hyperparathyroidism
Kidney Transplantation
Kidney Transplantation
Parathyroidectomy
Kidney Transplantation
Kidney Transplantation
Parathyroidectomy
Kidney Transplantation
Cinacalcet
Calcimimetic
Published in: Langenbeck's Archives of Surgery / Issue 1/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01755-4

ACC 2024 Congress

Springer Medicine

Parathyroidectomy versus cinacalcet for tertiary hyperparathyroidism; a retrospective analysis

Abstract

Introduction

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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