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Impact of post‐kidney transplant parathyroidectomy on allograft function
Author(s) -
Parikh Samir,
Nagaraja Haikady,
Agarwal Anil,
Samavedi Srinivas,
Visger Jon,
Nori Uday,
Andreoni Kenneth,
Pesavento Todd,
Singh Neeraj
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12099
Subject(s) - parathyroidectomy , medicine , urology , renal function , hyperparathyroidism , parathyroid hormone , secondary hyperparathyroidism , kidney transplantation , kidney transplant , kidney , endocrinology , gastroenterology , surgery , calcium
Background The impact of parathyroidectomy on allograft function in kidney transplant patients is unclear. Methods We conducted a retrospective, observational study of all kidney transplant recipients from 1988 to 2008 who underwent parathyroidectomy for uncontrolled hyperparathyroidism (n = 32). Post‐parathyroidectomy, changes in estimated glomerular filtration rate (e GFR ) and graft loss were recorded. Cross‐sectional associations at baseline between e GFR and serum calcium, phosphate, and parathyroid hormone ( PTH ), and associations between their changes within subjects during the first two months post‐parathyroidectomy were assessed. Results Post‐parathyroidectomy, the mean e GFR declined from 51.19 mL/min/1.73 m 2 at parathyroidectomy to 44.78 mL/min/1.73 m 2 at two months (p < 0.0001). Subsequently, graft function improved, and by 12 months, mean e GFR recovered to 49.76 mL/min/1.73 m 2 (p = 0.035). Decrease in serum PTH was accompanied by a decrease in e GFR (p = 0.0127) in the first two months post‐parathyroidectomy. Patients whose e GFR declined by ≥20% (group 1) in the first two months post‐parathyroidectomy were distinguished from the patients whose e GFR declined by <20% (group 2). The two groups were similar except that group 1 had a higher baseline mean serum PTH compared with group 2, although not significant (1046.7 ± 1034.2 vs. 476.6 ± 444.9, p = 0.14). In group 1, e GFR declined at an average rate of 32% (p < 0.0001) during the first month post‐parathyroidectomy compared with 7% (p = 0.1399) in group 2, and the difference between these two groups was significant (p = 0.0003). The graft function recovered in both groups by one yr. During median follow‐up of 66.00 ± 49.45 months, 6 (18%) patients lost their graft with a mean time to graft loss from parathyroidectomy of 37.2 ± 21.6 months. The causes of graft loss were rejection (n = 2), pyelonephritis (n = 1) and chronic allograft nephropathy (n = 3). No graft loss occurred during the first‐year post‐surgery. Conclusion Parathyroidectomy may lead to transient kidney allograft dysfunction with eventual recovery of graft function by 12 months post‐parathyroidectomy. Higher level of serum PTH pre‐parathyoidectomy is associated with a more profound decrease in e GFR post‐parathyroidectomy.