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- Title
Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation.
- Authors
van der Plas, Willemijn Y.; El Moumni, Mostafa; von Forstner, Philipp J.; Koh, Ezra Y.; Dulfer, Roderick R.; van Ginhoven, Tessa M.; Rotmans, Joris I.; Appelman-Dijkstra, Natasha M.; Schepers, Abbey; Hoorn, Ewout J.; Plukker, John Th. M.; Vogt, Liffert; Engelsman, Anton F.; Nieveen van Dijkum, Els J. M.; Kruijff, Schelto; Pol, Robert A.; de Borst, Martin H.
- Abstract
Background: 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.
- Subjects
KIDNEY transplantation; PARATHYROIDECTOMY; GENERALIZED estimating equations; CHRONIC kidney failure; UNIVERSITY hospitals
- Publication
World Journal of Surgery, 2019, Vol 43, Issue 8, p1972
- ISSN
0364-2313
- Publication type
Article
- DOI
10.1007/s00268-019-04952-w