Rongzhi Wang1, Faaiz Saad2, M Chandler McLeod1, Clifton Kew3, Gaurav Agarwal3, Keith Wille3, Jayme E Locke1, Herbert Chen1, Song Ong4. 1. Department of Surgery, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL, 35233, USA. 2. School of Medicine, The University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA. 3. Department of Medicine, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL, 35233, USA. 4. Department of Medicine, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL, 35233, USA. scong@uabmc.edu.
Abstract
BACKGROUND: Hyperparathyroidism is common in patients with end-stage kidney disease and may persist after kidney transplantation (KT). Parathyroidectomy (PTx) is curative, but whether PTx should be performed before or after KT remains controversial. There is concern that PTx can adversely affect renal allograft function if performed post-KT and result in persistent hypocalcemia. This study evaluated outcomes and postoperative complications of PTx before and after KT at our institution. METHODS: We performed a retrospective review of patients at our center (1/2012-2/2019) who had PTx either pre-KT or post-KT. Data on patient demographics, surgical outcomes, and postoperative complications of PTx were collected. RESULTS: Ninety-eight patients were included in this study, with 23 patients undergoing PTx before KT and 75 after KT. The length of follow-up after KT was 67.7 ± 25.5 months. In post-KT PTx patients, 30-day allograft function was unchanged after PTx. Calcium oxalate and phosphate crystals were less common on allograft biopsies in pre-KT PTx patients (10.0% vs. 34.8%, p = 0.038). Patients in the pre-KT group required more calcium supplementation after PTx than the post-KT group (p < 0.001). At one-year post-PTx, 17 (19.1%) patients required > 1000 mg elemental calcium per day and 7 (7.9%) patients required > 2000 mg/day. There was no difference in surgical success or postoperative complications between the two groups. CONCLUSIONS: Parathyroidectomy before or after kidney transplantation does not adversely affect allograft function. The incidence of persistent hypocalcemia was low. Parathyroidectomy is safe and effective either before or after kidney transplantation.
BACKGROUND: Hyperparathyroidism is common in patients with end-stage kidney disease and may persist after kidney transplantation (KT). Parathyroidectomy (PTx) is curative, but whether PTx should be performed before or after KT remains controversial. There is concern that PTx can adversely affect renal allograft function if performed post-KT and result in persistent hypocalcemia. This study evaluated outcomes and postoperative complications of PTx before and after KT at our institution. METHODS: We performed a retrospective review of patients at our center (1/2012-2/2019) who had PTx either pre-KT or post-KT. Data on patient demographics, surgical outcomes, and postoperative complications of PTx were collected. RESULTS: Ninety-eight patients were included in this study, with 23 patients undergoing PTx before KT and 75 after KT. The length of follow-up after KT was 67.7 ± 25.5 months. In post-KT PTx patients, 30-day allograft function was unchanged after PTx. Calcium oxalate and phosphate crystals were less common on allograft biopsies in pre-KT PTx patients (10.0% vs. 34.8%, p = 0.038). Patients in the pre-KT group required more calcium supplementation after PTx than the post-KT group (p < 0.001). At one-year post-PTx, 17 (19.1%) patients required > 1000 mg elemental calcium per day and 7 (7.9%) patients required > 2000 mg/day. There was no difference in surgical success or postoperative complications between the two groups. CONCLUSIONS: Parathyroidectomy before or after kidney transplantation does not adversely affect allograft function. The incidence of persistent hypocalcemia was low. Parathyroidectomy is safe and effective either before or after kidney transplantation.
Authors: M Wolzt; L Schmetterer; G Dorner; G Zelger; J Entlicher; S Kapiotis; H G Eichler Journal: J Clin Endocrinol Metab Date: 1997-08 Impact factor: 5.958
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