Yan Fu, Sun Zhou, Liang Guofu, Liu Chao, Niu Yulin
School of Clinical Medicine, Guizhou Medical University, Guiyang, Guizhou, China.
Organ Transplantation Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
Transplant Proc. 2024 Dec;56(10):2134-2143. doi: 10.1016/j.transproceed.2024.11.019. Epub 2024 Nov 29.
Secondary hyperparathyroidism (sHPT) is a common symptom of chronic kidney disease (CKD), and at the time of transplantation, more than two-thirds of patients with end-stage renal disease have secondary hyperparathyroidism. After kidney transplantation, parathyroid function is normalized in some kidney transplant recipients, but up to 50% of kidney transplant recipients develop tertiary hyperparathyroidism (tHPT) 1 year after kidney transplantation. The effect of parathyroidectomy on the grafts is currently unclear; thus, we conducted a meta-analysis of relevant studies to evaluate changes in graft function 1 year after parathyroidectomy, aiming to assess the procedure's safety in renal transplant recipients.
A thorough exploration was conducted across Embase, PubMed, Web of Science, and the Cochrane Library databases to gather pertinent literature spanning from January 1, 2000, to December 31, 2023. The search criteria encompassed terms such as "kidney transplantation," "parathyroidectomy," and "hyperparathyroidism."
Twelve studies were scrutinized to assess alterations in graft functionality at 1, 3, 6, and 12 months postparathyroidectomy. The meta-analysis unveiled a notable decline in overall glomerular filtration rate and a concurrent elevation in serum creatinine 1 year postparathyroidectomy, signifying an impairment in graft function compared to the preoperative phase. Significant heterogeneity was observed among the studies.
Following parathyroidectomy in renal transplant recipients 1 year postsurgery, calcium and parathyroid hormone levels normalized. Nonetheless, there was evident impairment in graft function and an elevated risk of graft loss. Hence, the safety of parathyroidectomy in patients with secondary hyperparathyroidism postrenal transplantation necessitates meticulous consideration.
继发性甲状旁腺功能亢进（sHPT）是慢性肾脏病（CKD）的常见症状，在移植时，超过三分之二的终末期肾病患者患有继发性甲状旁腺功能亢进。肾移植后，部分肾移植受者的甲状旁腺功能恢复正常，但高达50%的肾移植受者在肾移植后1年发生三发性甲状旁腺功能亢进（tHPT）。目前甲状旁腺切除术对移植物的影响尚不清楚；因此，我们对相关研究进行了荟萃分析，以评估甲状旁腺切除术后1年移植物功能的变化，旨在评估该手术在肾移植受者中的安全性。
全面检索了Embase、PubMed、Web of Science和Cochrane图书馆数据库，收集2000年1月1日至2023年12月31日期间的相关文献。检索标准包括“肾移植”、“甲状旁腺切除术”和“甲状旁腺功能亢进”等术语。
对12项研究进行了审查，以评估甲状旁腺切除术后1、3、6和12个月移植物功能的变化。荟萃分析显示，甲状旁腺切除术后1年，总体肾小球滤过率显著下降，血清肌酐同时升高，这表明与术前相比移植物功能受损。研究之间观察到显著的异质性。
肾移植受者甲状旁腺切除术后1年，钙和甲状旁腺激素水平恢复正常。然而，移植物功能明显受损，移植物丢失风险增加。因此，肾移植后继发性甲状旁腺功能亢进患者甲状旁腺切除术的安全性需要仔细考虑。
