Department of Medicine, Boston University Medical Center, Boston, MA, USA.
Transplantation. 2012 Nov 27;94(10):1041-8. doi: 10.1097/TP.0b013e31826c3968.
Hyperparathyroidism is present in up to 50% of transplant recipients 1 year after transplant, often despite good graft function. Posttransplant patients frequently have hypercalcemia-associated hyperparathyroidism, limiting the role of vitamin D analogues and sometimes requiring parathyroidectomy. Multiple observational studies have investigated treatment of posttransplant hyperparathyroidism with the calcimimetic agent cinacalcet.
We performed a systematic review and meta-analysis of prospective and retrospective studies from 2004 through January 26, 2012, using MEDLINE. We identified studies evaluating treatment with cinacalcet in renal transplant recipients with hyperparathyroidism. We performed random effects meta-analysis to determine changes in calcium, phosphorus, parathyroid hormone, and serum creatinine.
Twenty-one studies with 411 kidney transplant recipients treated with cinacalcet for hyperparathyroidism met inclusion criteria. Patients were treated for 3 to 24 months. By meta-analysis, calcium decreased by 1.14 mg/dL (95% confidence interval, -1.00 to -1.28), phosphorus increased by 0.46 mg/dL (95% confidence interval, 0.28-0.64), parathyroid hormone decreased by 102 pg/mL (95% confidence interval, -69 to -134), and there was no significant change in creatinine (0.02 mg/dL decrease; 95% confidence interval, -0.09 to 0.06). Cinacalcet resulted in hypocalcemia in seven patients. The most common side effect was gastrointestinal intolerance.
From nonrandomized studies, cinacalcet appears to be safe and effective for the treatment of posttransplant hyperparathyroidism. Larger observational studies and randomized controlled trials, performed over longer follow-up times and looking at clinical outcomes, are needed to corroborate these findings.
甲状旁腺功能亢进症在移植后 1 年内发生于多达 50%的移植受者中，尽管移植物功能通常良好。移植后患者常发生与高钙血症相关的甲状旁腺功能亢进症，限制了维生素 D 类似物的作用，有时甚至需要甲状旁腺切除术。多项观察性研究调查了使用拟钙剂西那卡塞治疗移植后甲状旁腺功能亢进症。
我们使用 MEDLINE 对 2004 年 1 月 26 日之前的前瞻性和回顾性研究进行了系统评价和荟萃分析。我们确定了评估西那卡塞治疗甲状旁腺功能亢进症的肾移植受者的研究。我们进行了随机效应荟萃分析，以确定钙、磷、甲状旁腺激素和血清肌酐的变化。
21 项研究（共 411 例肾移植患者）符合纳入标准，这些研究用西那卡塞治疗甲状旁腺功能亢进症。患者接受治疗的时间为 3 至 24 个月。荟萃分析显示，钙降低了 1.14mg/dL（95%置信区间：-1.00 至-1.28），磷增加了 0.46mg/dL（95%置信区间：0.28-0.64），甲状旁腺激素降低了 102pg/mL（95%置信区间：-69 至-134），肌酐无显著变化（降低 0.02mg/dL；95%置信区间：-0.09 至 0.06）。西那卡塞导致 7 例患者发生低钙血症。最常见的副作用是胃肠道不耐受。
来自非随机研究的结果表明，西那卡塞治疗移植后甲状旁腺功能亢进症似乎安全且有效。需要更大规模的观察性研究和随机对照试验，进行更长时间的随访并观察临床结局，以证实这些发现。
