Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
World J Surg. 2019 Aug;43(8):1972-1980. doi: 10.1007/s00268-019-04952-w.
Parathyroidectomy (PTx) is the treatment of choice for end-stage renal disease (ESRD) patients with therapy-resistant hyperparathyroidism (HPT). The optimal timing of PTx for ESRD-related HPT-before or after kidney transplantation (KTx)-is subject of debate.
Patients with ESRD-related HPT who underwent both PTx and KTx between 1994 and 2015 were included in a multicenter retrospective study in four university hospitals. Two groups were formed according to treatment sequence: PTx before KTx (PTxKTx) and PTx after KTx (KTxPTx). Primary endpoint was renal function (eGFR, CKD-EPI) between both groups at several time points post-transplantation. Correlation between the timing of PTx and KTx and the course of eGFR was assessed using generalized estimating equations (GEE).
The PTxKTx group consisted of 102 (55.1%) and the KTxPTx group of 83 (44.9%) patients. Recipient age, donor type, PTx type, and pre-KTx PTH levels were significantly different between groups. At 5 years after transplantation, eGFR was similar in the PTxKTx group (eGFR 44.5 ± 4.0 ml/min/1.73 m) and KTxPTx group (40.0 ± 6.4 ml/min/1.73 m, p = 0.43). The unadjusted GEE model showed that timing of PTx was not correlated with graft function over time (mean difference -1.0 ml/min/1.73 m, 95% confidence interval -8.4 to 6.4, p = 0.79). Adjustment for potential confounders including recipient age and sex, various donor characteristics, PTx type, and PTH levels did not materially influence the results.
In this multicenter cohort study, timing of PTx before or after KTx does not independently impact graft function over time.
甲状旁腺切除术（PTx）是治疗终末期肾病（ESRD）伴治疗抵抗性甲状旁腺功能亢进（HPT）患者的首选方法。PTx 治疗 ESRD 相关 HPT 的最佳时机——在肾移植（KTx）之前还是之后——仍存在争议。
纳入了 1994 年至 2015 年间在四所大学附属医院接受 PTx 和 KTx 的 ESRD 相关 HPT 患者进行多中心回顾性研究。根据治疗顺序将患者分为两组：PTx 先于 KTx（PTxKTx）和 KTx 先于 PTx（KTxPTx）。主要终点是移植后多个时间点两组患者的肾功能（eGFR，CKD-EPI）。使用广义估计方程（GEE）评估 PTx 和 KTx 时间与 eGFR 变化的相关性。
PTxKTx 组 102 例（55.1%），KTxPTx 组 83 例（44.9%）。两组患者的受体年龄、供体类型、PTx 类型和预 KTx 甲状旁腺激素水平有显著差异。移植后 5 年，PTxKTx 组 eGFR（44.5±4.0ml/min/1.73m）与 KTxPTx 组（40.0±6.4ml/min/1.73m）相似（p=0.43）。未调整的 GEE 模型显示，PTx 时间与移植物功能无相关性（平均差值-1.0ml/min/1.73m，95%置信区间-8.4 至 6.4，p=0.79）。调整受体年龄和性别、各种供体特征、PTx 类型和 PTH 水平等潜在混杂因素后，结果并未发生实质性改变。
在这项多中心队列研究中，PTx 在 KTx 前后的时机与移植物功能的时间变化无独立相关性。
