Ezra Y Koh1, Willemijn Y van der Plas2, Roderick R Dulfer3, Robert A Pol2, Schelto Kruijff2, Joris I Rotmans4, Natasha Appelman-Dijkstra4, Abbey Schepers5, Martin H de Borst6, Ewout J Hoorn7, Tessa M van Ginhoven3, Els J M Nieveen van Dijkum1, Liffert Vogt8, Anton F Engelsman9. 1. Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 AZ, Amsterdam, The Netherlands. 2. Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, Netherlands. 3. Department of Surgery, Erasmus Medical Center, University Rotterdam, Rotterdam, Netherlands. 4. Department of Nephrology, Leiden University Medical Center, University of Leiden, Leiden, Netherlands. 5. Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, Netherlands. 6. Department of Nephrology, Groningen University Medical Center, University of Groningen, Groningen, Netherlands. 7. Department of Nephrology, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands. 8. Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. 9. Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 AZ, Amsterdam, The Netherlands. antonengelsman@me.com.
Abstract
PURPOSE: Calcimimetics are currently indicated for severe secondary hyperparathyroidism (SHPT). However, the role of parathyroidectomy (PTX) for these patients is still under debate, and its impact on subsequent kidney transplantation (KTX) is unclear. In this study, we compare the outcomes of kidney transplantation after PTX or medical treatment. METHODS: Patients who underwent KTX and had SHPT were analyzed retrospectively. Two groups were selected (patients who had either PTX or calcimimetics prior to KTX) using a propensity score for sex, age, donor type, and parathyroid hormone levels (PTH) during dialysis. The primary outcome was graft failure, and secondary outcomes were surgical KTX complications, survival, serum PTH, serum calcium, and serum phosphate levels post-KTX. RESULTS: Matching succeeded for 92 patients. After PTX, PTH was significantly lower on the day of KTX as well as at 1 and 3 years post-KTX (14.00 pmol/L (3.80-34.00) vs. 71.30 pmol/L (30.70-108.30), p < 0.01, 10.10 pmol/L (2.00-21.00) vs. 32.35 pmol/L (21.58-51.76), p < 0.01 and 13.00 pmol/L (6.00-16.60) vs. 19.25 pmol/L (13.03-31.88), p = 0.027, respectively). No significant differences in post-KTX calcium and phosphate levels were noted between groups. Severe KTX complications were more common in the calcimimetics group (56.5% vs. 30.4%, p = 0.047). There were no differences in 10-year graft failure and overall survival. CONCLUSION: PTX resulted in lower PTH after KTX in comparison to patients who received calcimimetics. Severe complications were more common after calcimimetics, but graft failure and overall survival were similar.
PURPOSE: Calcimimetics are currently indicated for severe secondary hyperparathyroidism (SHPT). However, the role of parathyroidectomy (PTX) for these patients is still under debate, and its impact on subsequent kidney transplantation (KTX) is unclear. In this study, we compare the outcomes of kidney transplantation after PTX or medical treatment. METHODS:Patients who underwent KTX and had SHPT were analyzed retrospectively. Two groups were selected (patients who had either PTX or calcimimetics prior to KTX) using a propensity score for sex, age, donor type, and parathyroid hormone levels (PTH) during dialysis. The primary outcome was graft failure, and secondary outcomes were surgical KTX complications, survival, serum PTH, serum calcium, and serum phosphate levels post-KTX. RESULTS: Matching succeeded for 92 patients. After PTX, PTH was significantly lower on the day of KTX as well as at 1 and 3 years post-KTX (14.00 pmol/L (3.80-34.00) vs. 71.30 pmol/L (30.70-108.30), p < 0.01, 10.10 pmol/L (2.00-21.00) vs. 32.35 pmol/L (21.58-51.76), p < 0.01 and 13.00 pmol/L (6.00-16.60) vs. 19.25 pmol/L (13.03-31.88), p = 0.027, respectively). No significant differences in post-KTX calcium and phosphate levels were noted between groups. Severe KTX complications were more common in the calcimimetics group (56.5% vs. 30.4%, p = 0.047). There were no differences in 10-year graft failure and overall survival. CONCLUSION:PTX resulted in lower PTH after KTX in comparison to patients who received calcimimetics. Severe complications were more common after calcimimetics, but graft failure and overall survival were similar.