Meng C, Martins P, Frazão J, Pestana M
Nephrology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
Nephrology Department, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
Transplant Proc. 2017 May;49(4):795-798. doi: 10.1016/j.transproceed.2017.01.067.
Hyperparathyroidism is a common complication in chronic kidney disease and might persist in up to 25% of patients after transplantation. In this setting, vitamin D analogues further aggravate persistent hypercalcemia and cinacalcet has not been approved for these patients, some of whom will require parathyroidectomy to correct post-transplantation hyperparathyroidism.
In this single-center, retrospective study we aimed to analyze the long-term effect of parathyroidectomy on calcium, phosphorus, and parathyroid hormone (PTH) levels and its effect on allograft function in kidney transplantation patients submitted to parathyroidectomy.
Fifteen patients underwent parathyroidectomy between January 2005 and January 2015; median age 54 years old; 8 (53.3%) were receiving cinacalcet at the time of surgery. Pre-parathyroidectomy median values of intact PTH, calcium, and phosphorus were, respectively, 262 pg/mL, 10.8 mg/dL, and 2.4 mg/dL. Surgery consisted of uniglandular parathyroidectomy in 5 (33.3%) patients, biglandular in 4 (26.7%), and subtotal in 6 (40%). There was no surgery-related mortality.
Compared with baseline, there was a decrease of PTH (262 pg/mL vs. 106 pg/mL, P = .001), calcium, and phosphorus levels (10.8 mg/dL vs. 10.4 mg/dL, P = .3; 2.4 vs. 2.9 mg/dL, P = .05) 1 year after surgery; with normalization of serum calcium at the end of follow-up (10.8 mg/dL vs. 9.4 mg/dL, P = .04). A decrease in estimated glomerular filtration rate occurred 1 month post-surgery (62.7 mL/m vs. 49.7 mL/m, P = .006) but returned to baseline 1 year after surgery (62.7 mL/m vs. 60.8 mL/m, P = .73).
Parathyroidectomy appears to be a safe procedure and should be considered in kidney transplantation patients with persistent post-transplantation hyperparathyroidism. Although there was an acute estimated glomerular filtration rate decrease, we observed no long-term deterioration in allograft function.
甲状旁腺功能亢进是慢性肾脏病的常见并发症，移植后高达25%的患者可能持续存在该并发症。在这种情况下，维生素D类似物会进一步加重持续性高钙血症，且西那卡塞尚未被批准用于这些患者，其中一些患者需要进行甲状旁腺切除术来纠正移植后甲状旁腺功能亢进。
在这项单中心回顾性研究中，我们旨在分析甲状旁腺切除术对接受甲状旁腺切除术的肾移植患者的钙、磷和甲状旁腺激素（PTH）水平的长期影响及其对移植肾功能的影响。
2005年1月至2015年1月期间，15例患者接受了甲状旁腺切除术；中位年龄54岁；8例（53.3%）患者在手术时正在接受西那卡塞治疗。甲状旁腺切除术前，完整PTH、钙和磷的中位值分别为262 pg/mL、10.8 mg/dL和2.4 mg/dL。手术方式包括5例（33.3%）患者行单腺甲状旁腺切除术，4例（26.7%）行双腺甲状旁腺切除术，6例（40%）行次全甲状旁腺切除术。无手术相关死亡病例。
与基线相比，术后1年PTH水平下降（262 pg/mL对106 pg/mL，P = .001），钙和磷水平下降（10.8 mg/dL对10.4 mg/dL，P = .3；2.4对2.9 mg/dL，P = .05）；随访结束时血清钙恢复正常（10.8 mg/dL对9.4 mg/dL，P = .04）。术后1个月估计肾小球滤过率下降（62.7 mL/m对49.7 mL/m，P = .006），但术后1年恢复至基线水平（62.7 mL/m对60.8 mL/m，P = .73）。
甲状旁腺切除术似乎是一种安全的手术，对于移植后持续性甲状旁腺功能亢进的肾移植患者应予以考虑。尽管估计肾小球滤过率出现急性下降，但我们未观察到移植肾功能的长期恶化。
