甲状旁腺切除术在继发性甲状旁腺功能亢进的肾移植候选者中的时机：移植前与移植后早期或晚期甲状旁腺切除术的影响。
Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy.
机构信息
Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.
Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany; Department of Nephrology, Hannover Medical School, Hannover, Germany.
出版信息
Surgery. 2018 Feb;163(2):373-380. doi: 10.1016/j.surg.2017.10.016. Epub 2017 Dec 25.
BACKGROUND
The timing of parathyroidectomy in kidney transplant candidates suffering from secondary hyperparathyroidism before versus early or late after transplantation remains controversial.
METHODS
The short-term follow-up cohort comprised 66 patients with 1-year post-transplant follow-up, while the long-term follow-up cohort contained 123 patients. Risk-adjusted identification of independent risk factors for compromised renal graft function (KDIGO stage ≥ IV) was performed using multivariable regression analysis adjusted for propensity score logits for parathyroidectomy before versus after renal transplantation. Intra-individual matched-pairs analyses were used to identify significant effects of post-transplant parathyroidectomy on graft function as assessed by estimated glomerular filtration rate (eGFR) and paired t tests.
RESULTS
Donor kidney function KDIGO stage III (P = .030; OR = 5.191, 95% CI: 1.100-24.508), donor blood group 0 (P = .005; OR = 0.176, 95% CI: 0.048-0.642), and post-transplant parathyroidectomy (P = .032; OR = 17.849, 95% CI: 1.086-293.268) were revealed as independent significant risk factors for compromised renal graft function in the short-term follow-up cohort using propensity score risk adjustment while post-transplant parathyroidectomy had no independent influence in the long-term follow-up cohort (P = .651). Parathyroidectomy after renal transplantation compromised graft function early after parathyroidectomy and at last follow-up in all post-transplant parathyroidectomy cases (P ≤ .004). Parathyroidectomy within the first post-transplant year was associated with compromised renal graft function until last follow-up (P = .004), while parathyroidectomy late post-transplant was not.
CONCLUSION
Parathyroidectomy should be conducted before transplantation or, if this is not possible, preferably after the first post-transplant year.
背景
对于患有继发性甲状旁腺功能亢进症的肾移植候选者，甲状旁腺切除术的时间是在移植前、移植早期还是晚期进行仍存在争议。
方法
短期随访队列包括 66 例患者，随访时间为移植后 1 年，而长期随访队列包括 123 例患者。使用多变量回归分析，对甲状旁腺切除术在肾移植前与肾移植后进行风险调整，识别影响移植后肾功能（KDIGO 分期≥IV 期）的独立危险因素，并使用配对个体匹配分析来确定移植后甲状旁腺切除术对肾小球滤过率（eGFR）评估的移植物功能的显著影响，采用配对 t 检验。
结果
使用倾向评分风险调整，在短期随访队列中，发现供体肾脏功能 KDIGO 分期 III 期（P=.030；OR=5.191，95%CI：1.100-24.508）、供体血型 0 型（P=.005；OR=0.176，95%CI：0.048-0.642）和移植后甲状旁腺切除术（P=.032；OR=17.849，95%CI：1.086-293.268）是影响移植后肾功能的独立显著危险因素，而在长期随访队列中，移植后甲状旁腺切除术没有独立影响（P=.651）。在所有接受甲状旁腺切除术的病例中，移植后甲状旁腺切除术早期和最后一次随访时，都会损害移植物功能（P≤.004）。移植后第一年的甲状旁腺切除术与最后一次随访时的移植肾功能受损有关（P=.004），而移植后晚期的甲状旁腺切除术则没有。
结论
甲状旁腺切除术应在移植前进行，如果这不可能，最好在移植后第一年进行。
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