肾移植后甲状旁腺切除术对移植物功能的影响。
Impact of post-kidney transplant parathyroidectomy on allograft function.
机构信息
Division of Nephrology, Department of Internal Medicine, The Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
出版信息
Clin Transplant. 2013 May-Jun;27(3):397-402. doi: 10.1111/ctr.12099. Epub 2013 Feb 28.
BACKGROUND
The impact of parathyroidectomy on allograft function in kidney transplant patients is unclear.
METHODS
We conducted a retrospective, observational study of all kidney transplant recipients from 1988 to 2008 who underwent parathyroidectomy for uncontrolled hyperparathyroidism (n = 32). Post-parathyroidectomy, changes in estimated glomerular filtration rate (eGFR) and graft loss were recorded. Cross-sectional associations at baseline between eGFR and serum calcium, phosphate, and parathyroid hormone (PTH), and associations between their changes within subjects during the first two months post-parathyroidectomy were assessed.
RESULTS
Post-parathyroidectomy, the mean eGFR declined from 51.19 mL/min/1.73 m(2) at parathyroidectomy to 44.78 mL/min/1.73 m(2) at two months (p < 0.0001). Subsequently, graft function improved, and by 12 months, mean eGFR recovered to 49.76 mL/min/1.73 m(2) (p = 0.035). Decrease in serum PTH was accompanied by a decrease in eGFR (p = 0.0127) in the first two months post-parathyroidectomy. Patients whose eGFR declined by ≥20% (group 1) in the first two months post-parathyroidectomy were distinguished from the patients whose eGFR declined by <20% (group 2). The two groups were similar except that group 1 had a higher baseline mean serum PTH compared with group 2, although not significant (1046.7 ± 1034.2 vs. 476.6 ± 444.9, p = 0.14). In group 1, eGFR declined at an average rate of 32% (p < 0.0001) during the first month post-parathyroidectomy compared with 7% (p = 0.1399) in group 2, and the difference between these two groups was significant (p = 0.0003). The graft function recovered in both groups by one yr. During median follow-up of 66.00 ± 49.45 months, 6 (18%) patients lost their graft with a mean time to graft loss from parathyroidectomy of 37.2 ± 21.6 months. The causes of graft loss were rejection (n = 2), pyelonephritis (n = 1) and chronic allograft nephropathy (n = 3). No graft loss occurred during the first-year post-surgery.
CONCLUSION
Parathyroidectomy may lead to transient kidney allograft dysfunction with eventual recovery of graft function by 12 months post-parathyroidectomy. Higher level of serum PTH pre-parathyoidectomy is associated with a more profound decrease in eGFR post-parathyroidectomy.
背景
甲状旁腺切除术对肾移植患者同种异体移植物功能的影响尚不清楚。
方法
我们对 1988 年至 2008 年间所有因甲状旁腺功能亢进症未得到控制而行甲状旁腺切除术的肾移植受者进行了回顾性观察性研究（n=32）。记录甲状旁腺切除术后估算肾小球滤过率（eGFR）和移植物丢失的变化。在基线时评估 eGFR 与血清钙、磷和甲状旁腺激素（PTH）之间的横断面关联，以及在甲状旁腺切除术后两个月内受试者体内它们的变化之间的关联。
结果
甲状旁腺切除术后，eGFR 从甲状旁腺切除时的 51.19 mL/min/1.73 m(2)降至术后两个月时的 44.78 mL/min/1.73 m(2)（p<0.0001）。随后，移植物功能得到改善，12 个月时，平均 eGFR 恢复至 49.76 mL/min/1.73 m(2)（p=0.035）。甲状旁腺切除术后两个月内，血清 PTH 下降与 eGFR 下降相关（p=0.0127）。甲状旁腺切除术后两个月内 eGFR 下降≥20%（第 1 组）的患者与 eGFR 下降<20%（第 2 组）的患者不同。两组相似，除了第 1 组的基线平均血清 PTH 高于第 2 组，但无显著差异（1046.7±1034.2 与 476.6±444.9，p=0.14）。第 1 组术后第一个月 eGFR 以平均 32%的速度下降（p<0.0001），而第 2 组以 7%的速度下降（p=0.1399），两组之间的差异具有统计学意义（p=0.0003）。两组的移植物功能均在一年时恢复。在中位数为 66.00±49.45 个月的中位随访期间，6 例（18%）患者失去了移植物，从甲状旁腺切除术到移植物丢失的平均时间为 37.2±21.6 个月。移植物丢失的原因是排斥反应（n=2）、肾盂肾炎（n=1）和慢性同种异体移植肾病（n=3）。术后第一年无移植物丢失。
结论
甲状旁腺切除术可能导致同种异体肾移植功能短暂障碍，最终在甲状旁腺切除术后 12 个月恢复移植物功能。甲状旁腺切除术前较高的血清 PTH 水平与甲状旁腺切除术后 eGFR 下降更显著相关。
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