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

• Published in: Surgery 2018-02, Vol.163 (2), p.373-380
• Main Authors: Littbarski, Simon A., Kaltenborn, Alexander, Gwiasda, Jill, Beneke, Jan, Arelin, Viktor, Schwager, Ysabell, Stupak, Julia V., Marcheel, Indra L., Emmanouilidis, Nikos, Jäger, Mark D., Scheumann, Georg Friedrich Wilhelm, Klempnauer, Jürgen, Schrem, Harald
• Format: Article
• Language: English
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2017.10.016

The timing of parathyroidectomy in kidney transplant candidates suffering from secondary hyperparathyroidism before versus early or late after transplantation remains controversial. The short-term follow-up cohort comprised 66 patients with 1-year post-transplant follow-up, while the long-term follow-up cohort contained 123 patients. Risk-adjusted identification of independent risk factors for compromised renal graft function (KDIGO stage ≥ IV) was performed using multivariable regression analysis adjusted for propensity score logits for parathyroidectomy before versus after renal transplantation. Intra-individual matched-pairs analyses were used to identify significant effects of post-transplant parathyroidectomy on graft function as assessed by estimated glomerular filtration rate (eGFR) and paired t tests. Donor kidney function KDIGO stage III (P = .030; OR = 5.191, 95% CI: 1.100–24.508), donor blood group 0 (P = .005; OR = 0.176, 95% CI: 0.048–0.642), and post-transplant parathyroidectomy (P = .032; OR = 17.849, 95% CI: 1.086–293.268) were revealed as independent significant risk factors for compromised renal graft function in the short-term follow-up cohort using propensity score risk adjustment while post-transplant parathyroidectomy had no independent influence in the long-term follow-up cohort (P = .651). Parathyroidectomy after renal transplantation compromised graft function early after parathyroidectomy and at last follow-up in all post-transplant parathyroidectomy cases (P ≤ .004). Parathyroidectomy within the first post-transplant year was associated with compromised renal graft function until last follow-up (P = .004), while parathyroidectomy late post-transplant was not. Parathyroidectomy should be conducted before transplantation or, if this is not possible, preferably after the first post-transplant year.