Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Transpl Int. 2012 Dec;25(12):1248-56. doi: 10.1111/j.1432-2277.2012.01564.x. Epub 2012 Sep 29.
We performed retrospective, multi-center study of the impacts of parathyroidectomy (PTX) after or before kidney transplantation on allograft outcomes. A total of 63 patients who underwent PTX after kidney transplantation were identified. Deterioration in eGFR by more than 25% at 1 month after PTX occurred in 20% of the patients. The baseline eGFR was significantly lower in impairment group than nonimpairment group [adjusted odds ratio (OR) 0.87, 95% confidence interval (CI) 0.77-0.99, P = 0.033]. Low iPTH concentration after PTX was also a significant risk factor for the renal impairment (OR 0.96, CI 0.94-0.99, P = 0.009). A total of 37 patients who underwent PTX before transplantation were identified. Thirty-six percent of the patients had persistent hyperparathyroidism by 1 year after transplantation. A high iPTH level before PTX was a significant risk factor for persistent post-transplant hyperparathyroidism (adjusted OR 1.002, CI 1.000-1.005, P = 0.039). Finally, eGFR values during the first 5 years after transplantation were significantly lower in the patients who underwent PTX at less than 1 year after transplantation, than the pretransplant PTX patients (P = 0.032). As PTX after kidney transplantation has a risk of deterioration of allograft function, pretransplant PTX should be considered for patients with severe hyperparathyroidism, who could undergo post-transplant PTX.
我们进行了回顾性、多中心研究，探讨甲状旁腺切除术（PTX）在肾移植后或前对移植物结局的影响。共确定了 63 例肾移植后行 PTX 的患者。20%的患者在 PTX 后 1 个月 eGFR 下降超过 25%。损伤组的基线 eGFR 明显低于非损伤组[校正优势比（OR）0.87，95%置信区间（CI）0.77-0.99，P=0.033]。PTX 后 iPTH 浓度低也是肾功能损害的显著危险因素（OR 0.96，CI 0.94-0.99，P=0.009）。共确定了 37 例在移植前接受 PTX 的患者。36%的患者在移植后 1 年内仍存在甲状旁腺功能亢进。PTX 前高 iPTH 水平是持续性移植后甲状旁腺功能亢进的显著危险因素（校正 OR 1.002，CI 1.000-1.005，P=0.039）。最后，与移植前 PTX 患者相比，PTX 后 1 年内接受移植的患者在移植后 5 年内 eGFR 值明显更低（P=0.032）。由于肾移植后行 PTX 有损害移植物功能的风险，对于甲状旁腺功能亢进严重的患者，应考虑在移植前行 PTX，随后可进行移植后 PTX。
