University Hospitals Cleveland Medical Center, OH.
University Hospitals Cleveland Medical Center, OH.
Surgery. 2024 Dec;176(6):1617-1622. doi: 10.1016/j.surg.2024.08.010. Epub 2024 Sep 19.
Parathyroidectomy has been shown to be superior to medical management in treating hypercalcemia and preserving renal allograft function in patients with tertiary hyperparathyroidism after kidney transplant. Despite this evidence, parathyroidectomy remains underused. We aimed to evaluate outcomes in patients with tertiary hyperparathyroidism after kidney transplant based on management strategy (cinacalcet or parathyroidectomy) and optimal timing of parathyroidectomy.
Data from TriNetX Dataworks included adult kidney transplant patients diagnosed with tertiary hyperparathyroidism between 1998 and 2021. Patients who underwent parathyroidectomy were compared with those receiving cinacalcet. Subgroups based on parathyroidectomy timing after transplant were analyzed (within 6 months, 6 months to 1 year, and between 1 and 3 years). Descriptive statistics and relative risks were calculated using TriNetX Live.
Patients receiving cinacalcet (n = 162) had a 77% higher risk of persistent hypercalcemia and a 73% higher risk of elevated parathyroid hormone levels than those who underwent parathyroidectomy (n = 338) within 3-10 years after the index event (start of cinacalcet or surgery). Parathyroidectomy performed 1 year after transplant (n = 132) was associated with a 57% lower risk of kidney stone formation and patients were 2 times more likely to maintain normal glomerular filtration rate than parathyroidectomy performed 1-3 years after transplant (n = 57). Even earlier parathyroidectomy (within 6 months of kidney transplant, n = 55) showed a 62% lower risk of persistent hypercalcemia, hyperphosphatemia, and kidney stone formation than surgery between 6 months and 1 year after transplant (n = 77).
Parathyroidectomy is more effective than cinacalcet in managing tertiary hyperparathyroidism after kidney transplant. In addition, opting for early parathyroidectomy (within 6 months after transplant) could enhance long-term outcomes.
甲状旁腺切除术已被证明在治疗肾移植后三发性甲状旁腺功能亢进症患者的高钙血症和保留肾移植功能方面优于药物治疗。尽管有这方面的证据，但甲状旁腺切除术的应用仍然不足。我们旨在根据管理策略（西那卡塞或甲状旁腺切除术）和甲状旁腺切除术的最佳时机评估肾移植后三发性甲状旁腺功能亢进症患者的结局。
TriNetX Dataworks 中的数据包括 1998 年至 2021 年间诊断为三发性甲状旁腺功能亢进症的成年肾移植患者。将接受甲状旁腺切除术的患者与接受西那卡塞治疗的患者进行比较。根据移植后甲状旁腺切除术的时间（6 个月内、6 个月至 1 年和 1 至 3 年）进行亚组分析。使用 TriNetX Live 计算描述性统计和相对风险。
在索引事件（开始使用西那卡塞或手术）后 3-10 年内，接受西那卡塞治疗的患者（n=162）持续高钙血症的风险比接受甲状旁腺切除术的患者（n=338）高 77%，甲状旁腺激素水平升高的风险高 73%。移植后 1 年（n=132）进行甲状旁腺切除术与肾结石形成风险降低 57%相关，与移植后 1-3 年（n=57）进行甲状旁腺切除术相比，患者维持正常肾小球滤过率的可能性增加 2 倍。甚至更早的甲状旁腺切除术（移植后 6 个月内，n=55）与移植后 6 个月至 1 年内手术相比，持续高钙血症、高磷血症和肾结石形成的风险降低 62%。
甲状旁腺切除术在治疗肾移植后三发性甲状旁腺功能亢进症方面比西那卡塞更有效。此外，选择早期甲状旁腺切除术（移植后 6 个月内）可以改善长期结局。
