Parathyroidectomy is underused in patients with tertiary hyperparathyroidism after renal transplantation.

Abstract

BACKGROUND:

Parathyroidectomy (PTX) is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), PTX can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of PTX in patients with posttransplant 3HPT with the advent of cinacalcet.

METHODS:

We evaluated renal transplant patients between January 1, 2004, and June 30, 2012, with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) at 1 year after successful renal transplantation with normocalcemia or hypercalcemia were defined as having 3HPT. A multivariate logistic regression model was constructed to determine factors associated with undergoing PTX.

RESULTS:

We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent PTX. Patients with higher levels of serum calcium (P < .001) and PTH (P = .002) posttransplant were more likely to be referred for PTX. Importantly, those who underwent PTX had serum calcium and PTH values distributed more closely to the normal range on most recent follow-up. PTX was not associated with rejection (P = .400) or with worsened allograft function (P = .163).

CONCLUSION:

PTX seems to be underused in patients with 3HPT at our institution. PTX is associated with high cure rates, improved serum calcium and PTH levels, and is not associated with rejection.

• Authors: Irene Lou, David F Schneider, Glen Leverson, David Foley, Rebecca Sippel, Herbert Chen
• Journal: Surgery (Surgery) Vol. 159 Issue 1 Pg. 172-9 (Jan 2016) ISSN: 1532-7361 [Electronic] United States
• PMID: 26603850 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Inc. All rights reserved.

Chemical References

• Benzoates
• Calcimimetic Agents
• BAY 58-2667

Topics

• Adult
• Benzoates (therapeutic use)
• Calcimimetic Agents (therapeutic use)
• Female
• Humans
• Hyperparathyroidism (drug therapy, etiology, surgery)
• Kidney Failure, Chronic (surgery)
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Parathyroidectomy