Management of Post-transplant Hyperparathyroidism and Bone Disease

Santos, Rowena Delos; Rossi, Ana P.; Coyne, Daniel W.; Maw, Thin Thin

doi:10.1007/s40265-019-01074-4

Cited by 47 publications

(20 citation statements)

References 96 publications

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“…Importantly in the present context, late post-transplantation anaemia 14 and persistent secondary hyperparathyroidism 15 have been reported in up to 35% and 50% of kidney transplant recipients, respectively. Conceptually, anaemia and hyperparathyroidism could mediate impaired diastolic function in kidney transplant recipients.…”

Section: Introductionmentioning

confidence: 60%

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Hsu¹,

Norton²,

Peters³

et al. 2021

IJNRD

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Introduction We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients. Methods We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by ultrasound, arterial function by applanation tonometry using SphygmoCor software and diastolic function by echocardiography in 43 kidney transplant recipients with a transplant duration of ≥6 months, no acute rejection and a glomerular filtration rate of ≥15 mL/min/1.73m 2 . Results Mean (SD; range) transplant duration was 12.3 (8.0; 0.5–33.8) years. Post transplantation anaemia and persistent secondary hyperparathyroidism were identified in 27.9% and 30.8% of the patients, respectively; 67.5% of the participants were overweight or obese. In established confounder adjusted analysis, haemoglobin (partial R =−0.394, p=0.01) and parathyroid hormone concentrations (partial R =0.382, p=0.02) were associated with E/e’. In multivariable analysis, haemoglobin (partial R =−0.278, p=0.01) and parathyroid levels (partial R =0.324, p=0.04) were independently associated with E/e’. Waist–height ratio (partial R =−0.526, p=0.001 and partial R =−0.355, p=0.03), waist circumference (partial R =−0.433, p=0.008 and partial R =−0.393, p=0.02) and body mass index (partial R =−0.332, p=0.04 and partial R =−0.489, p=0.002) were associated with both e’ and E/A, respectively, in established confounder adjusted analysis. The haemoglobin-E/e’ (partial R =−0.422, p=0.02), parathyroid hormone-E/e’ (partial R =0.434, p=0.03), waist–height ratio-e’ (partial R =−0.497, p=0.007) and body mass index-E/A (partial R =−0.386, p=0.04) relationships remained consistent after additional adjustment for left ventricular mass index and cardiac preload and afterload measures. Conclusion Haemoglobin and parathyroid hormone concentrations as well as adiposity measures are independently associated with diastolic function in kidney transplant recipients. Whether adequate management of post transplantation anaemia, persistent secondary hyperparathyroidism and excess adiposity can prevent the development of heart failure with preserved ejection fraction in kidney transplant recipients merits further investigation.

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Section: Introductionmentioning

confidence: 60%

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Hsu¹,

Norton²,

Peters³

et al. 2021

IJNRD

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“…PT-HPT occurs in 45 and 20% of kidney transplantation recipients after 2 years and 5 years, respectively [1]. The main cause of PT-HPT is enlarged and autonomous adenomas with dysregulated metabolic bone mineral parameters, even when the renal function of the allograft recovers to normal [3]. Studies have reported that PT-HPT is associated with an elevated risk of fractures, cardiovascular disease, allograft loss (5%) and mortality (4%) [4, 5, 11, 12].…”

Section: Discussionmentioning

confidence: 99%

“…Following kidney transplantation, parathyroid hyperplasia may slowly regress during recovery [2]. However, persistent post-transplant hyperparathyroidism (PT-HPT) is common because monoclonal parathyroid tissue either has a reduced response or lacks the typical response to physiologic regulatory mechanisms of parathyroid secretion and proliferation [3]. PT-HPT puts patients at high risk for bone fractures, mortality and renal graft loss [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma in a patient with kidney transplantation: a case report

Yang

Zhang

et al. 2019

BMC Nephrol

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BackgroundPersistent hyperparathyroidism after kidney transplantation has been associated with adverse outcomes. Parathyroidectomy is the definitive treatment approach, but the success of parathyroidectomy relies on the accurate preoperative localization of the culprit parathyroid lesions. Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma present important diagnostic challenges. Here, we describe a patient with kidney transplantation who underwent successful surgery after being evaluated with functional and structural imaging.Case presentationA 53-year-old man presented with potentially malignant multifocal thyroid nodules by ultrasonography 2 years after kidney transplantation. The patient had hypercalcaemia and persistent hyperparathyroidism. Thyroid papillary carcinoma was confirmed in the left thyroid nodules by fine-needle aspiration biopsy. The right superior thyroid hypoechoic nodule was 1.2 cm in size and showed marked uptake of the tracer 99mTcO4-sestamibi during single-photon emission computed tomography/computed tomography (SPECT/CT); additionally, a cystic parathyroid lesion without tracer uptake was present behind the left superior pole of the thyroid. The histological examination demonstrated the coexistence of right intrathyroidal parathyroid adenomas, left cystic parathyroid nodular hyperplasia and multifocal papillary thyroid carcinoma. At the 6-month follow-up, the serum calcium levels were within the normal range, and the patient’s kidney function remained stable.ConclusionsSimultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma in a patient with kidney transplantation is a rare clinical scenario. Physicians must be aware that the combination of functional (SPECT/CT) and structural (ultrasonography) imaging is highly successful in diagnosing patients with coexistent intrathyroidal parathyroid adenomas and papillary thyroid carcinoma.

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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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Management of Post-transplant Hyperparathyroidism and Bone Disease

Cited by 47 publications

References 96 publications

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients

Simultaneous intrathyroidal parathyroid adenomas and multifocal papillary thyroid carcinoma in a patient with kidney transplantation: a case report

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

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