From the Department of Department of Nephrology, Uludag University Medical School, Bursa, Turkey.
Exp Clin Transplant. 2021 Apr;19(4):316-323. doi: 10.6002/ect.2018.0221. Epub 2018 Oct 19.
Persistent hyperparathyroidism can have a deleterious effect on graft function in kidney transplant recipients, although serum calcium, phosphorus, and parathyroid hormone levels tend to normalize after successful transplant. Parathyroidectomy can result in sustained amelioration of persistent hyperparathyroidism despite graft failure risk and unfavorable graft outcomes. Data on this issue are limited and conflicting. Here, we evaluated the effects of parathyroidectomy on graft function in kidney transplant recipients.
This retrospective study included 249 adult kidney transplant recipients (121 deceased-donor/128 living-donor; 142 males/107 females; mean age of 39.3 ± 11.6 y; mean follow-up of 46.5 ± 23.5 mo). Participants were grouped as those without (n = 222), those with pretransplant (n = 12), and those with posttransplant (n = 15) parathyroidectomy. Graft outcomes and serum calcium, phosphorus, and parathyroid hormone levels were studied.
Serum calcium levels at baseline and at 1, 3, 6, and 12 months and parathyroid hormone levels at baseline and at 6 and 12 months were higher and serum phosphorus levels at 3, 6, and 12 months were lower in the posttransplant parathyroidectomy group versus the other groups (P < .001). We observed no significant differences between groups regarding serum calcium, phosphorus, and parathyroid hormone levels at last visit. Estimated glomerular filtration rates at 3, 6, and 12 months and at last visit in the pretransplant parathyroidectomy group were higher than in those without parathyroidectomy (P < .05) and higher at 6 and 12 months than in the posttransplant parathyroidectomy group (P < .05). No significant differences regarding graft loss and patient mortality were observed among the 3 groups (P > .05).
Parathyroidectomy resulted in sustained decreased levels of serum calcium and parathyroid hormone. We observed no graft failure risk associated with parathyroidectomy in our study. Parathyroidectomy before transplant is advantageous with better graft function.
甲状旁腺功能亢进症可对肾移植受者的移植物功能产生有害影响，尽管在成功移植后血清钙、磷和甲状旁腺激素水平趋于正常。甲状旁腺切除术可导致甲状旁腺功能亢进症持续改善，尽管存在移植物失败风险和不利的移植物结局。关于这个问题的数据有限且存在冲突。在这里，我们评估了甲状旁腺切除术对肾移植受者移植物功能的影响。
这项回顾性研究纳入了 249 名成年肾移植受者（121 名已故供体/128 名活体供体；142 名男性/107 名女性；平均年龄 39.3±11.6 岁；平均随访时间 46.5±23.5 个月）。参与者被分为无甲状旁腺切除术组（n=222）、移植前甲状旁腺切除术组（n=12）和移植后甲状旁腺切除术组（n=15）。研究了移植物结局以及血清钙、磷和甲状旁腺激素水平。
与其他组相比，移植后甲状旁腺切除术组在基线和术后 1、3、6 和 12 个月时血清钙水平以及在基线和术后 6 和 12 个月时甲状旁腺激素水平更高，而在术后 3、6 和 12 个月时血清磷水平更低（P<0.001）。在最后一次就诊时，各组之间的血清钙、磷和甲状旁腺激素水平没有显著差异。在移植前甲状旁腺切除术组，术后 3、6 和 12 个月以及最后一次就诊时的估算肾小球滤过率均高于无甲状旁腺切除术组（P<0.05），且在术后 6 和 12 个月时高于移植后甲状旁腺切除术组（P<0.05）。三组之间在移植物丢失和患者死亡率方面无显著差异（P>0.05）。
甲状旁腺切除术导致血清钙和甲状旁腺激素水平持续下降。我们在研究中未观察到甲状旁腺切除术与移植物失败风险相关。在移植前进行甲状旁腺切除术有利于改善移植物功能。
