Department of Surgery.
Department of Internal Medicine, Division of Nephrology.
Int J Surg. 2024 Feb 1;110(2):902-908. doi: 10.1097/JS9.0000000000000894.
Surgery for irreversible hyperparathyroidism is the preferred management for kidney transplant patients. The authors analyzed the factors associated with persistent hypercalcemia after parathyroidectomy in kidney transplant patients and evaluated the appropriate extent of surgery.
The authors retrospectively analyzed 100 patients who underwent parathyroidectomy because of persistent hyperparathyroidism after kidney transplantation at a tertiary medical center between June 2011 and February 2022. Patients were divided into two groups: 22 with persistent hypercalcemia after parathyroidectomy and 78 who achieved normocalcemia after parathyroidectomy. Persistent hypercalcemia was defined as having sustained hypercalcemia (≥10.3 mg/dl) 6 months after kidney transplantation. The authors compared the biochemical and clinicopathological features between the two groups. Multivariate logistic regression analysis was used to identify potential risk factors associated with persistent hypercalcemia following parathyroidectomy.
The proportion of patients with serum intact parathyroid hormone (PTH) level is greater than 65 pg/ml was significantly high in the hypercalcemia group (40.9 vs. 7.7%). The proportion of patients who underwent less than subtotal parathyroidectomy was significantly high in the persistent hypercalcemia group (17.9 vs. 54.5%). Patients with a large remaining size of the preserved parathyroid gland (≥0.8 cm) had a high incidence of persistent hypercalcemia (29.7 vs. 52.6%). In the multivariate logistic regression analysis, the drop rate of intact PTH is less than 88% on postoperative day 1 (odds ratio 10.3, 95% CI: 2.7-39.1, P =0.001) and the removal of less than or equal to 2 parathyroid glands (odds ratio 6.8, 95% CI: 1.8-26.7, P =0.001) were identified as risk factors for persistent hypercalcemia.
The drop rate of intact PTH is less than 88% on postoperative day 1 and appropriate extent of surgery for controlling the autonomic function were independently associated with persistent hypercalcemia. Confirmation of parathyroid lesions through frozen section biopsy or intraoperative PTH monitoring can be helpful in preventing the inadvertent removal of a parathyroid gland and achieving normocalcemia after parathyroidectomy.
对于肾功能衰竭接受肾移植的患者，不可逆甲状旁腺功能亢进的手术治疗是首选的管理方式。作者分析了甲状旁腺切除术后持续性高钙血症与肾移植患者相关的因素，并评估了手术的适当范围。
作者回顾性分析了 2011 年 6 月至 2022 年 2 月在一家三级医疗中心因肾移植后持续性甲状旁腺功能亢进而接受甲状旁腺切除术的 100 例患者。患者分为两组：甲状旁腺切除术后仍存在持续性高钙血症的 22 例患者和甲状旁腺切除术后血钙恢复正常的 78 例患者。持续性高钙血症定义为肾移植后 6 个月持续存在高钙血症（≥10.3mg/dl）。作者比较了两组之间的生化和临床病理特征。使用多变量逻辑回归分析来确定甲状旁腺切除术后持续性高钙血症相关的潜在危险因素。
高钙血症组的血清全段甲状旁腺激素（PTH）水平大于 65pg/ml 的患者比例明显较高（40.9% vs. 7.7%）。甲状旁腺切除术后行不完全甲状旁腺切除术的患者比例在持续性高钙血症组明显较高（17.9% vs. 54.5%）。残留甲状旁腺较大（≥0.8cm）的患者持续性高钙血症的发生率较高（29.7% vs. 52.6%）。多变量逻辑回归分析显示，术后第 1 天 PTH 下降率<88%（比值比 10.3，95%可信区间：2.7-39.1，P=0.001）和切除甲状旁腺数量≤2 个（比值比 6.8，95%可信区间：1.8-26.7，P=0.001）是持续性高钙血症的危险因素。
术后第 1 天 PTH 下降率<88%和适当的手术范围以控制自主功能与持续性高钙血症独立相关。通过冰冻切片活检或术中 PTH 监测确认甲状旁腺病变有助于防止无意中切除甲状旁腺，并在甲状旁腺切除术后实现血钙正常化。
