Willemijn Y van der Plas1, Mostafa El Moumni1, Philipp J von Forstner1, Ezra Y Koh2, Roderick R Dulfer3, Tessa M van Ginhoven3, Joris I Rotmans4, Natasha M Appelman-Dijkstra5, Abbey Schepers6, Ewout J Hoorn7, John Th M Plukker1, Liffert Vogt8, Anton F Engelsman2, Els J M Nieveen van Dijkum2, Schelto Kruijff1, Robert A Pol1, Martin H de Borst9. 1. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 2. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. 4. Department of Nephrology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands. 5. Department of Endocrinology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands. 6. Department of Surgery, Leiden University Medical Center, Leiden University, Leiden, The Netherlands. 7. Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. 8. Department of Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 9. Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. m.h.de.borst@umcg.nl.
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.
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-KTxPTH 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.
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