Garcia-Montemayor V, Sánchez-Agesta M, Agüera M L, Calle Ó, Navarro M D, Rodríguez A, Aljama P
Department of Nephrology, University Hospital Reina Sofía, Córdoba, Spain.
Department of Nephrology, University Hospital Reina Sofía, Córdoba, Spain.
Transplant Proc. 2019 Mar;51(2):344-349. doi: 10.1016/j.transproceed.2018.12.012. Epub 2018 Dec 12.
Persistence of secondary hyperparathyroidism (SHPT) is common after renal transplantation. Good diagnosis and treatment are important to avoid complications. The objective of our work was to perform a retrospective analysis of the evolution of SHPT after renal transplantation. We selected patients who had received a kidney transplant at our hospital between 2000 and 2014. The biochemical variables of chronic kidney disease-metabolic bone disorders (CKD-MBD) were collected at pretransplantation and at 3, 6, 12, and 24 months post-transplantation. Treatments related to SHPT were also analyzed. Five hundred forty-three renal transplants were included. The average preoperative parathyroid hormone (PTH) was 241.14 pg/mL, 115.7 pg/mL at 3 months, and at 12 and 24 months postoperatively, PTH levels stabilized to 112 pg/mL. Treatment related to SHPT was present in 27.3% of patients during the preoperative period, 40.4% at 3 months postoperatively, 24.2% at 12 months postoperatively, and 23.2% at 24 months postoperatively. There was a significant association between requiring some type of treatment preoperatively and the rest of the postoperative periods (P < .005). The sample was later divided into 3 groups based on preoperative PTH (1: <150 pg/mL, n = 223 [41.1%]; 2: 150-300 pg/mL, n = 173 [31.9%]; 3: >300 pg/mL, n = 147 [27.1%]) and their evolutions were compared. Higher levels of postoperative PTH in group pre-PTH 3 were observed. Group 3 also presented with greater need for treatment in the postoperative periods, with significant association (P < .05). A regression analysis was performed and found that postoperative PTH were dependent on preoperative PTH adjusted by glomerular filtration. In conclusion, parameters related to CKD-MBD (mainly PTH) after kidney transplant, dependent on preoperative levels and glomerular filtration. Patients with a greater grade of SHPT presented with higher levels of postoperative PTH despite receiving more intensive treatment.
肾移植后继发性甲状旁腺功能亢进（SHPT）持续存在的情况很常见。良好的诊断和治疗对于避免并发症很重要。我们这项工作的目的是对肾移植后SHPT的演变进行回顾性分析。我们选择了2000年至2014年间在我院接受肾移植的患者。收集了慢性肾脏病 - 代谢性骨病（CKD - MBD）在移植前以及移植后3、6、12和24个月时的生化变量。还分析了与SHPT相关的治疗情况。共纳入543例肾移植患者。术前甲状旁腺激素（PTH）平均水平为241.14 pg/mL，3个月时为115.7 pg/mL，术后12个月和24个月时，PTH水平稳定在112 pg/mL。术前27.3%的患者接受了与SHPT相关的治疗，术后3个月为40.4%，术后12个月为24.2%，术后24个月为23.2%。术前需要某种类型治疗与术后其余各时间段之间存在显著关联（P <.005）。样本随后根据术前PTH分为3组（1组：<150 pg/mL，n = 223 [41.1%]；2组：150 - 300 pg/mL，n = 173 [31.9%]；3组：>300 pg/mL，n = 147 [27.1%]），并比较了它们的演变情况。观察到术前PTH 3组术后PTH水平更高。3组在术后各时间段也更需要治疗，存在显著关联（P <.05）。进行了回归分析，发现术后PTH依赖于经肾小球滤过调整后的术前PTH。总之，肾移植后与CKD - MBD相关的参数（主要是PTH），依赖于术前水平和肾小球滤过。尽管接受了更强化的治疗，但SHPT程度较高的患者术后PTH水平更高。
