BACKGROUND: Parathyroidectomy (PTX) is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), PTX can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of PTX in patients with posttransplant 3HPT with the advent of cinacalcet. METHODS: We evaluated renal transplant patients between January 1, 2004, and June 30, 2012, with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) at 1 year after successful renal transplantation with normocalcemia or hypercalcemia were defined as having 3HPT. A multivariate logistic regression model was constructed to determine factors associated with undergoing PTX. RESULTS: We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent PTX. Patients with higher levels of serum calcium (P < .001) and PTH (P = .002) posttransplant were more likely to be referred for PTX. Importantly, those who underwent PTX had serum calcium and PTH values distributed more closely to the normal range on most recent follow-up. PTX was not associated with rejection (P = .400) or with worsened allograft function (P = .163). CONCLUSION: PTX seems to be underused in patients with 3HPT at our institution. PTX is associated with high cure rates, improved serum calcium and PTH levels, and is not associated with rejection.
BACKGROUND: Parathyroidectomy (PTX) is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), PTX can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of PTX in patients with posttransplant 3HPT with the advent of cinacalcet. METHODS: We evaluated renal transplant patients between January 1, 2004, and June 30, 2012, with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) at 1 year after successful renal transplantation with normocalcemia or hypercalcemia were defined as having 3HPT. A multivariate logistic regression model was constructed to determine factors associated with undergoing PTX. RESULTS: We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent PTX. Patients with higher levels of serum calcium (P < .001) and PTH (P = .002) posttransplant were more likely to be referred for PTX. Importantly, those who underwent PTX had serum calcium and PTH values distributed more closely to the normal range on most recent follow-up. PTX was not associated with rejection (P = .400) or with worsened allograft function (P = .163). CONCLUSION:PTX seems to be underused in patients with 3HPT at our institution. PTX is associated with high cure rates, improved serum calcium and PTH levels, and is not associated with rejection.
Authors: Peter F Nichol; James R Starling; Eberhard Mack; Jason J Klovning; Bryan N Becker; Herbert Chen Journal: Ann Surg Date: 2002-05 Impact factor: 12.969
Authors: Frederic Triponez; Electron Kebebew; David Dosseh; Quan-Yang Duh; Marc Hazzan; Christian Noel; Glenn M Chertow; François Wambergue; Dominique Fleury; Vincent Lemaitre; Charles A G Proye; Orlo H Clark Journal: Surgery Date: 2006-12 Impact factor: 3.982
Authors: Andreas L Serra; Albin A Schwarz; Franziska H Wick; Hans-Peter Marti; Rudolf P Wüthrich Journal: Nephrol Dial Transplant Date: 2005-06-07 Impact factor: 5.992
Authors: Willemijn Y van der Plas; Mostafa El Moumni; Philipp J von Forstner; Ezra Y Koh; Roderick R Dulfer; Tessa M van Ginhoven; Joris I Rotmans; Natasha M Appelman-Dijkstra; Abbey Schepers; Ewout J Hoorn; John Th M Plukker; Liffert Vogt; Anton F Engelsman; Els J M Nieveen van Dijkum; Schelto Kruijff; Robert A Pol; Martin H de Borst Journal: World J Surg Date: 2019-08 Impact factor: 3.352
Authors: R R Dulfer; E Y Koh; W Y van der Plas; A F Engelsman; E J M Nieveen van Dijkum; R A Pol; L Vogt; M H de Borst; S Kruijff; A Schepers; N M Appelman-Dijkstra; J I Rotmans; D A Hesselink; C H J van Eijck; E J Hoorn; T M van Ginhoven Journal: Langenbecks Arch Surg Date: 2019-02-07 Impact factor: 3.445
Authors: Willemijn Y van der Plas; Anton F Engelsman; Akin Özyilmaz; Anouk N van der Horst-Schrivers; Kornelis Meijer; Gooitzen M van Dam; Robert A Pol; Martin H de Borst; Schelto Kruijff Journal: Ann Surg Oncol Date: 2016-07-26 Impact factor: 5.344