Glenda G Callender1, Jennifer Malinowski2, Mahsa Javid2, Yawei Zhang3, Huang Huang3, Courtney E Quinn2, Tobias Carling2, Ricarda Tomlin4, J Douglas Smith5, Sanjay Kulkarni4. 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.
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.
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: Aarti Mathur; JiYoon B Ahn; Whitney Sutton; Martha A Zeiger; Dorry L Segev; Mara McAdams-DeMarco Journal: Surgery Date: 2022-03-21 Impact factor: 4.348
Authors: Aarti Mathur; Whitney Sutton; JiYoon B Ahn; Jason D Prescott; Martha A Zeiger; Dorry L Segev; Mara McAdams-DeMarco Journal: Transplantation Date: 2021-12-01 Impact factor: 5.385