Karniadakis Ioannis, Stefanopoulos Leandros, Balomenakis Charalampos, Geropoulos Georgios, Psarras Kyriakos, Koimtzis Georgios
Department of General Surgery, St. George's University Hospital, London SW9 0QT, UK.
Department of Electrical and Computer Engineering, Northwestern University, 633 Clark St., Evanston, IL 60208, USA.
J Clin Med. 2025 Aug 22;14(17):5939. doi: 10.3390/jcm14175939.
Tertiary hyperparathyroidism following kidney transplantation is a well-recognized complication in patients with pre-existing mineral imbalances due to chronic renal failure. Parathyroidectomy remains the only definitively curative option for tertiary hyperparathyroidism. The optimal timing of parathyroidectomy, before or after transplantation, is debated in the literature. This study aims to assess whether parathyroidectomy timing affects the successful resolution of tertiary hyperparathyroidism in patients with a functional kidney transplant. We conducted a systematic review and meta-analysis of the available literature collating the effect of pre- versus post-transplantation parathyroidectomy on the resolution of tertiary hyperparathyroidism. We compared the follow-up parathyroid hormone and calcium levels of patients subjected to either of these two approaches. Three studies were identified, encompassing a total of 223 patients. The meta-analysis of available data yielded no statistically significant difference between pre- and post-kidney transplantation parathyroidectomy in terms of serum parathyroid hormone (SMD -0.19, 95% CI -0.92 to 0.55, = 0.62) and calcium levels (SMD -0.75, 95% CI -2.30 to 0.80, = 0.35). We demonstrated no significant difference between pre- and post-transplantation parathyroidectomy when it comes to the treatment of tertiary hyperparathyroidism. This meta-analysis is limited by the small number of studies included, reducing its statistical power. Therefore, additional studies are required to identify the optimal timing of intervention for the effective management of tertiary hyperparathyroidism in kidney transplant recipients.
肾移植后发生的三发性甲状旁腺功能亢进是慢性肾衰竭导致矿物质失衡患者中一种公认的并发症。甲状旁腺切除术仍然是治疗三发性甲状旁腺功能亢进的唯一具有确切疗效的选择。甲状旁腺切除术的最佳时机是在移植前还是移植后，这在文献中存在争议。本研究旨在评估甲状旁腺切除术的时机是否会影响功能性肾移植患者三发性甲状旁腺功能亢进的成功缓解。我们对现有文献进行了系统综述和荟萃分析，整理了移植前与移植后甲状旁腺切除术对三发性甲状旁腺功能亢进缓解的影响。我们比较了接受这两种方法之一的患者的随访甲状旁腺激素和钙水平。共确定了三项研究，涉及223名患者。对现有数据的荟萃分析显示，移植前和移植后甲状旁腺切除术在血清甲状旁腺激素方面（标准化均数差 -0.19，95%可信区间 -0.92至0.55，P = 0.62）和钙水平方面（标准化均数差 -0.75，95%可信区间 -2.30至0.80，P = 0.35）均无统计学显著差异。在治疗三发性甲状旁腺功能亢进方面，我们证明移植前和移植后甲状旁腺切除术之间没有显著差异。这项荟萃分析受到纳入研究数量较少的限制，降低了其统计效力。因此，需要更多研究来确定肾移植受者有效管理三发性甲状旁腺功能亢进的最佳干预时机。
