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Surgery. 2017 Jan;161(1):44-50. doi: 10.1016/j.surg.2016.10.003. Epub 2016 Nov 15.

Parathyroidectomy prior to kidney transplant decreases graft failure.

Author information

1
Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT. Electronic address: glenda.callender@yale.edu.
2
Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
3
Department of Surgery, Section of Surgical Outcomes and Epidemiology, Yale University School of Medicine, New Haven, CT.
4
Department of Surgery, Section of Transplantation Surgery, Yale University School of Medicine, New Haven, CT.
5
Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT.

Abstract

BACKGROUND:

Uncorrected uremic hyperparathyroidism is associated with delayed graft function after kidney transplantation. The current guidelines of the Kidney Disease Improving Global Outcomes recommend maintaining parathyroid hormone ≤9x normal in patients pre-kidney transplantation. This study explores the effect of increased levels of serum parathyroid hormone and preoperative parathyroidectomy on outcomes after kidney transplantation.

METHODS:

A retrospective review was performed of adult patients who underwent kidney transplantation between January 1, 2005, and December 31, 2014, at a single institution. Biochemistries and outcomes were analyzed pre-kidney transplantation and at 30 days, 6 months, and 1 year post-kidney transplantation.

RESULTS:

A total of 913 patients underwent kidney transplantation from 2005-2014. Graft survival 1 year post-kidney transplantation was 97.8%. Overall, 462 (50.6%) patients had a pre-kidney transplantation diagnosis of uncorrected uremic hyperparathyroidism, which was associated with complications in the first year post-kidney transplantation (odds ratio 1.44; 95% confidence interval, 1.11-1.87); no statistical association with delayed graft function or graft failure was detected. Pre-kidney transplantation parathyroid hormone ≥6x normal was associated with post-kidney transplantation graft failure (P < .05). A total of 57 (6.2%) patients underwent pre-kidney transplantation parathyroidectomy, which was associated with lesser risk of graft failure (odds ratio: 0.547; 95% confidence interval, 0.327-0.913), but no statistically significant association with delayed graft function or complications were detected.

CONCLUSION:

Pre-kidney transplantation parathyroidectomy decreases post-kidney transplantation graft failure and may benefit patients whose serum parathyroid hormone levels decrease into the target range of current Kidney Disease Improving Global Outcomes guidelines.

Comment in

PMID:
27863776
DOI:
10.1016/j.surg.2016.10.003
[Indexed for MEDLINE]

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