The Influence of Parathyroidectomy on Osteoporotic Fractures in Kidney Transplant Recipients: Results from a Retrospective Single-Center Trial

Abstract

Kidney transplant (KTx) recipients are a high-risk population for osteoporotic fractures. We herein aim to identify the role of pre-transplant parathyroidectomy (PTX) and other modifiable factors associated with osteoporotic fractures in KTx recipients. We conducted a retrospective study involving 711 adult patients (4608 patient-years) who were transplanted at our center between January 2007 and June 2015. Clinical data were extracted from patients’ electronic medical records. Different laboratory and clinical parameters for mineral bone disease (MBD) and osteoporosis, including medication, were evaluated. We chose fracture events unrelated to malignancies or adequate trauma as the primary endpoint. Osteoporotic fractures occurred in 47 (6.6%) patients (median 36.7 months, IQR 45.9) after KTx (fracture incidence of 10 per 1000 person-years). Prior to KTx, subtotal PTX was performed in 116 patients (16.3%, median time 4.2 years before KTx, IQR 5.0). Of the patients with fracture (n = 47), only one (2.2%) patient had previously undergone PTX. After adjusting for the known fracture risk factors MBD and osteoporosis, PTX remained a protective factor against fractures (HR 0.134, CI 0.018–0.991, p = 0.049). We observed a reduced risk for pathological fractures in KTx patients who underwent PTX, independent from elevated parathyroid hormone at the time of KTx or afterwards.

Progress and Recent Advances in Solid Organ Transplantation

“…In addition to progress in desensitization and preoperative monitoring of donor-specific antibodies, this Special Issue also provided insights into the monitoring and management of chronic active antibody-mediated rejection [17]. Furthermore, investigators also shed light on post-transplant complication research, including osteoporotic fractures [9], diarrhea [15], psychological changes [19], and recurrent primary disease [17].…”

“…In this Special Issue, "Progress and Recent Advances in Solid Organ Transplantation", researchers from different disciplines with different expertise and resources highlighted the novelty of their recent investigations in the field of organ transplantation, including issues related to donors, allografts, and patient survival [8][9][10][11][12][13][14][15][16][17][18][19][20]. While there have been significant advances in regional and national kidney paired-donation programs in matching incompatible pairs, data suggest that there may be a role for desensitization in select cases to facilitate organ transplantation [21].…”