Effect of parathyroidectomy after renal transplantation on grafted kidney function within one year: a meta-analysis

Abstract

Objective: 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) one year after kidney transplantation. The effect of parathyroidectomy on the grafts is currently unclear, so we conducted a meta-analysis of these studies to assess the changes in graft function one year after parathyroidectomy after kidney transplantation to investigate the resection in renal transplant recipients. Methods: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." Results:Twelve studies were scrutinized to assess alterations in graft functionality at 1, 3, 6, and 12 months post-parathyroidectomy. The meta-analysis unveiled a notable decline in overall glomerular filtration rate and a concurrent elevation in serum creatinine one year post-parathyroidectomy, signifying an impairment in graft function compared to the preoperative phase. Significant heterogeneity was observed among the studies. Conclusion: Following parathyroidectomy in renal transplant recipients one year post-surgery, 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 post-renal transplantation necessitates meticulous consideration.