Callender Glenda G, Malinowski Jennifer, Javid Mahsa, Zhang Yawei, Huang Huang, Quinn Courtney E, Carling Tobias, Tomlin Ricarda, Smith J Douglas, Kulkarni Sanjay
Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
Surgery. 2017 Jan;161(1):44-50. doi: 10.1016/j.surg.2016.10.003. Epub 2016 Nov 15.
Uncorrected uremic hyperparathyroidism is associated with delayed graft function after kidney transplantation. The current guidelines of the Kidney Disease Improving Global Outcomes recommend maintaining parathyroid hormone ≤9x normal in patients pre-kidney transplantation. This study explores the effect of increased levels of serum parathyroid hormone and preoperative parathyroidectomy on outcomes after kidney transplantation.
A retrospective review was performed of adult patients who underwent kidney transplantation between January 1, 2005, and December 31, 2014, at a single institution. Biochemistries and outcomes were analyzed pre-kidney transplantation and at 30 days, 6 months, and 1 year post-kidney transplantation.
A total of 913 patients underwent kidney transplantation from 2005-2014. Graft survival 1 year post-kidney transplantation was 97.8%. Overall, 462 (50.6%) patients had a pre-kidney transplantation diagnosis of uncorrected uremic hyperparathyroidism, which was associated with complications in the first year post-kidney transplantation (odds ratio 1.44; 95% confidence interval, 1.11-1.87); no statistical association with delayed graft function or graft failure was detected. Pre-kidney transplantation parathyroid hormone ≥6x normal was associated with post-kidney transplantation graft failure (P < .05). A total of 57 (6.2%) patients underwent pre-kidney transplantation parathyroidectomy, which was associated with lesser risk of graft failure (odds ratio: 0.547; 95% confidence interval, 0.327-0.913), but no statistically significant association with delayed graft function or complications were detected.
Pre-kidney transplantation parathyroidectomy decreases post-kidney transplantation graft failure and may benefit patients whose serum parathyroid hormone levels decrease into the target range of current Kidney Disease Improving Global Outcomes guidelines.
未经纠正的尿毒症性甲状旁腺功能亢进与肾移植后移植肾功能延迟相关。改善全球肾脏病预后组织的现行指南建议，肾移植术前患者的甲状旁腺激素水平应维持在正常水平的9倍以下。本研究探讨血清甲状旁腺激素水平升高及术前甲状旁腺切除术对肾移植术后结局的影响。
对2005年1月1日至2014年12月31日在单一机构接受肾移植的成年患者进行回顾性研究。分析肾移植术前、术后30天、6个月和1年时的生化指标及结局。
2005 - 2014年共有913例患者接受了肾移植。肾移植术后1年的移植物存活率为97.8%。总体而言，462例（50.6%）患者在肾移植术前被诊断为未经纠正的尿毒症性甲状旁腺功能亢进，这与肾移植术后第一年的并发症相关（比值比1.44；95%置信区间，1.11 - 1.87）；未检测到与移植肾功能延迟或移植物失败有统计学关联。肾移植术前甲状旁腺激素≥正常水平6倍与肾移植术后移植物失败相关（P <.05）。共有57例（6.2%）患者在肾移植术前接受了甲状旁腺切除术，这与移植物失败风险较低相关（比值比：0.547；95%置信区间，0.327 - 0.913），但未检测到与移植肾功能延迟或并发症有统计学显著关联。
肾移植术前甲状旁腺切除术可降低肾移植术后移植物失败的风险，可能使血清甲状旁腺激素水平降至改善全球肾脏病预后组织现行指南目标范围的患者受益。
