Jung Suyun, Kim Hyosang, Kwon Hyunwook, Shin Sung, Kim Young Hoon, Kim Won Woong, Sung Tae-Yon, Lee Yu-Mi, Chung Ki-Wook, Park Su-Kil, Baek Chung Hee
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2022 Jul;41(4):473-481. doi: 10.23876/j.krcp.21.210. Epub 2022 Feb 22.
Hyperparathyroidism is common in patients with chronic kidney disease with reduced renal function and has been observed after kidney transplantation. The optimal treatment for cases in which hyperparathyroidism persists after kidney transplantation has not been determined.
This retrospective study included 83 patients with tertiary hyperparathyroidism who underwent kidney transplantation between 2000 and 2018 at a single tertiary center in Korea. Sixty-four patients underwent parathyroidectomy and 19 patients were treated with cinacalcet following renal transplantation. Biochemical parameters and clinical outcomes were compared between the two groups.
Serum calcium and parathyroid hormone (PTH) levels improved in both the parathyroidectomy and cinacalcet groups. One year after treatment, parathyroidectomy resulted in a lower mean serum calcium level than cinacalcet (9.7 ± 0.7 mg/dL vs. 10.5 ± 0.7 mg/dL, p = 0.001). Regarding serum PTH, the parathyroidectomy group showed a significantly lower PTH level than the cinacalcet group at 6 months (129.1 ± 80.3 pg/mL vs. 219.2 ± 92.5 pg/mL, p = 0.002) and 1 year (118.8 ± 75.5 pg/mL vs. 250.6 ± 94.5 pg/ mL, p < 0.001). There was no statistically significant difference in the incidence of kidney transplant rejection, graft failure, cardiovascular events, fracture risk, or bone mineral density changes between the two groups.
Parathyroidectomy appears to reduce PTH and calcium levels effectively in tertiary hyperparathyroidism. However, creatinine level and allograft rejection should be monitored closely.
甲状旁腺功能亢进在肾功能减退的慢性肾病患者中很常见，并且在肾移植后也有观察到。肾移植后甲状旁腺功能亢进持续存在的病例的最佳治疗方法尚未确定。
这项回顾性研究纳入了2000年至2018年期间在韩国一家三级中心接受肾移植的83例三发性甲状旁腺功能亢进患者。64例患者接受了甲状旁腺切除术，19例患者在肾移植后接受了西那卡塞治疗。比较了两组的生化参数和临床结果。
甲状旁腺切除术组和西那卡塞组的血清钙和甲状旁腺激素（PTH）水平均有所改善。治疗1年后，甲状旁腺切除术组的平均血清钙水平低于西那卡塞组（9.7±0.7mg/dL对10.5±0.7mg/dL，p=0.001）。关于血清PTH，甲状旁腺切除术组在6个月时（129.1±80.3pg/mL对219.2±92.5pg/mL，p=0.002）和1年时（118.8±75.5pg/mL对250.6±94.5pg/mL，p<0.001）的PTH水平明显低于西那卡塞组。两组在肾移植排斥反应、移植失败、心血管事件、骨折风险或骨密度变化的发生率上没有统计学显著差异。
甲状旁腺切除术似乎能有效降低三发性甲状旁腺功能亢进患者的PTH和钙水平。然而，应密切监测肌酐水平和同种异体移植排斥反应。
