Effect of Incomplete Parathyroidectomy Preserving Entire Parathyroid Glands on Renal Graft Function

Jäger, Mark D.; Kaaden, Stephan; Emmanouilidis, Nikos; Lück, R.; Beckmann, Jan; Güner, Zeynep Esra; Kespohl, Holger; Glockzin, Kristina; Aselmann, H.; Kaudel, C.P.; Schwarz, Anke; Zapf, Antonia; Klempnauer, Jürgen; Scheumann, G. F. W.

doi:10.1001/archsurg.2011.138

Cited by 16 publications

(6 citation statements)

References 23 publications

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“…Twelve studies described the effect of parathyroidectomy for tertiary HPT on renal function after kidney transplantation ( Table ). Eleven of the 12 articles were considered of high quality, one article was considered fair quality.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of surgical and medical treatment for tertiary hyperparathyroidism

Dulfer

Franssen

Hesselink

et al. 2017

British Journal of Surgery

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Section: Resultsmentioning

confidence: 99%

Systematic review of surgical and medical treatment for tertiary hyperparathyroidism

Dulfer

Franssen

Hesselink

et al. 2017

British Journal of Surgery

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“…Finally, the retrospective design with the medium sample size and short-term follow-up time in this study require further large-scale, prospective studies with a longer follow-up period to confirm our findings. Despite these limitations, this study included more patients than the previous studies, which included only small numbers of patients (at most 83) [29]. Furthermore, we simultaneously analyzed the impacts of PTX both before and after kidney transplantation, and demonstrated for the first time that only early post-transplant PTX has a greater risk for post-PTX renal impairment.…”

Section: Discussionmentioning

confidence: 99%

Impact of parathyroidectomy on allograft outcomes in kidney transplantation

Jeon¹,

Kim²,

Kwon³

et al. 2012

Transplant International

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Summary We performed retrospective, multi‐center study of the impacts of parathyroidectomy (PTX) after or before kidney transplantation on allograft outcomes. A total of 63 patients who underwent PTX after kidney transplantation were identified. Deterioration in eGFR by more than 25% at 1 month after PTX occurred in 20% of the patients. The baseline eGFR was significantly lower in impairment group than nonimpairment group [adjusted odds ratio (OR) 0.87, 95% confidence interval (CI) 0.77–0.99, P = 0.033]. Low iPTH concentration after PTX was also a significant risk factor for the renal impairment (OR 0.96, CI 0.94–0.99, P = 0.009). A total of 37 patients who underwent PTX before transplantation were identified. Thirty‐six percent of the patients had persistent hyperparathyroidism by 1 year after transplantation. A high iPTH level before PTX was a significant risk factor for persistent post‐transplant hyperparathyroidism (adjusted OR 1.002, CI 1.000–1.005, P = 0.039). Finally, eGFR values during the first 5 years after transplantation were significantly lower in the patients who underwent PTX at less than 1 year after transplantation, than the pretransplant PTX patients (P = 0.032). As PTX after kidney transplantation has a risk of deterioration of allograft function, pretransplant PTX should be considered for patients with severe hyperparathyroidism, who could undergo post‐transplant PTX.

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“…Despite the fact that subtotal parathyroidectomies may have an increased risk of recurrent HPT (from 5% to 30%) compared to total parathyroidectomies, the subtotal parathyroidectomies are associated with lower rates of hypoparathyroidism and preservation of renal function 14,16,17 . There is evidence that removal of parathyroid tissue accompanied by an abrupt decrease in PTH is related to worsening renal function, possibly due to the loss of the vasodilatory effect of PTH in afferent renal arteriole and vasoconstrictor effect in efferent renal arteriole 15,18 .…”

Section: Discussionmentioning

confidence: 99%

Outcome of subtotal parathyroidectomy for surgical treatment of hyperparathyroidism after renal transplantation

Neves¹,

Fonseca²,

Koike³

et al. 2019

Arch. Head Neck Surg.

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Introduction: Parathyroidectomy (PTX) is one of the forms to treat hyperparathyroidism (HPT) after renal transplantation (RT), but choosing the appropriate surgical technique is controversial. The option for more conservative surgeries, such as subtotal parathyroidectomy (STPX), has been expanding owing to the lower risk of definitive HPT and its effectiveness in controlling hypercalcemia. Objective: To evaluate the efficacy of STPX as a definitive treatment for hyperparathyroidism after renal transplantation (HPT-RT) and determine whether there is a relationship between percentage intraoperative parathyroid hormone (ioPTH) decay levels and parathyroid hormone (PTH) values on the first postoperative day and surgical success. Methods: This retrospective study analyzed the medical records of prospectively followed patients diagnosed with HPT-RT submitted to STPX in two tertiary hospitals (Brazilian Unified Health System-SUS) for two years. Patients were allocated in two groups according to operative success (SGnormalization of ionized calcium (iCa) and PTH six months after surgery) or operative failure (FG-persistence of high iCa and PTH). The percentage ioPTH decay levels and the postoperative PTH absolute values on the first postoperative day were evaluated in both groups. Results: Of the total sample of 31 patients, surgical treatment was successful in 27 cases (87%). No statistically significant differences were observed between the groups for the percentage ioPTH decay levels (SG = 71.51% vs. FG = 70.4%), as well as for the PTH absolute values on the first postoperative day (SG = 52.69pg/ mL vs. FG = 54.55pg/mL). Conclusion: Subtotal parathyroidectomy is an effective and safe procedure for treating HPT-RT; however, the use of PTH levels remains subjective and cannot be considered as a predictor of surgical success.

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Effect of Incomplete Parathyroidectomy Preserving Entire Parathyroid Glands on Renal Graft Function

Cited by 16 publications

References 23 publications

Systematic review of surgical and medical treatment for tertiary hyperparathyroidism

Systematic review of surgical and medical treatment for tertiary hyperparathyroidism

Impact of parathyroidectomy on allograft outcomes in kidney transplantation

Outcome of subtotal parathyroidectomy for surgical treatment of hyperparathyroidism after renal transplantation

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