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Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation: a propensity-matched analysis (vol 405, pg 851, 2020)
Get PDFAn Erratum to this paper has been published:Vascular Surger
Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation
Get PDFBackground 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 m2
) and KTxPTx group
(40.0 ± 6.4 ml/min/1.73 m2
, 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 m2
, 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
