Simon A Littbarski1, Alexander Kaltenborn1, Jill Gwiasda1, Jan Beneke1, Viktor Arelin2, Ysabell Schwager1, Julia V Stupak1, Indra L Marcheel1, Nikos Emmanouilidis3, Mark D Jäger4, Georg Friedrich Wilhelm Scheumann3, Jürgen Klempnauer3, Harald Schrem5. 1. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany. 2. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany; Department of Nephrology, Hannover Medical School, Hannover, Germany. 3. General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. 4. General, Visceral and Minimally Invasive Surgery, Municipal Hospital Wolfenbüttel, Hannover, Germany. 5. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany; General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. Electronic address: schrem.harald@mh-hannover.de.
Abstract
BACKGROUND: The timing of parathyroidectomy in kidney transplant candidates suffering from secondary hyperparathyroidism before versus early or late after transplantation remains controversial. METHODS: The short-term follow-up cohort comprised 66 patients with 1-year post-transplant follow-up, while the long-term follow-up cohort contained 123 patients. Risk-adjusted identification of independent risk factors for compromised renal graft function (KDIGO stage ≥ IV) was performed using multivariable regression analysis adjusted for propensity score logits for parathyroidectomy before versus after renal transplantation. Intra-individual matched-pairs analyses were used to identify significant effects of post-transplant parathyroidectomy on graft function as assessed by estimated glomerular filtration rate (eGFR) and paired t tests. RESULTS: Donor kidney function KDIGO stage III (P = .030; OR = 5.191, 95% CI: 1.100-24.508), donor blood group 0 (P = .005; OR = 0.176, 95% CI: 0.048-0.642), and post-transplant parathyroidectomy (P = .032; OR = 17.849, 95% CI: 1.086-293.268) were revealed as independent significant risk factors for compromised renal graft function in the short-term follow-up cohort using propensity score risk adjustment while post-transplant parathyroidectomy had no independent influence in the long-term follow-up cohort (P = .651). Parathyroidectomy after renal transplantation compromised graft function early after parathyroidectomy and at last follow-up in all post-transplant parathyroidectomy cases (P ≤ .004). Parathyroidectomy within the first post-transplant year was associated with compromised renal graft function until last follow-up (P = .004), while parathyroidectomy late post-transplant was not. CONCLUSION: Parathyroidectomy should be conducted before transplantation or, if this is not possible, preferably after the first post-transplant year.
BACKGROUND: The timing of parathyroidectomy in kidney transplant candidates suffering from secondary hyperparathyroidism before versus early or late after transplantation remains controversial. METHODS: The short-term follow-up cohort comprised 66 patients with 1-year post-transplant follow-up, while the long-term follow-up cohort contained 123 patients. Risk-adjusted identification of independent risk factors for compromised renal graft function (KDIGO stage ≥ IV) was performed using multivariable regression analysis adjusted for propensity score logits for parathyroidectomy before versus after renal transplantation. Intra-individual matched-pairs analyses were used to identify significant effects of post-transplant parathyroidectomy on graft function as assessed by estimated glomerular filtration rate (eGFR) and paired t tests. RESULTS:Donor kidney function KDIGO stage III (P = .030; OR = 5.191, 95% CI: 1.100-24.508), donor blood group 0 (P = .005; OR = 0.176, 95% CI: 0.048-0.642), and post-transplant parathyroidectomy (P = .032; OR = 17.849, 95% CI: 1.086-293.268) were revealed as independent significant risk factors for compromised renal graft function in the short-term follow-up cohort using propensity score risk adjustment while post-transplant parathyroidectomy had no independent influence in the long-term follow-up cohort (P = .651). Parathyroidectomy after renal transplantation compromised graft function early after parathyroidectomy and at last follow-up in all post-transplant parathyroidectomy cases (P ≤ .004). Parathyroidectomy within the first post-transplant year was associated with compromised renal graft function until last follow-up (P = .004), while parathyroidectomy late post-transplant was not. CONCLUSION: Parathyroidectomy should be conducted before transplantation or, if this is not possible, preferably after the first post-transplant year.
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; 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