TY - JOUR
T1 - Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation: a propensity-matched analysis
AU - Koh, Ezra Y.
AU - van der Plas, Willemijn Y.
AU - Dulfer, Roderick R.
AU - Pol, Robert A.
AU - Kruijf, Schelto
AU - Rotmans, Joris I.
AU - Appelman-Dijkstra, Natasha
AU - Schepers, Abbey
AU - de Borst, Martin H.
AU - Hoorn, Ewout J.
AU - van Ginhoven, Tessa
AU - Nieveen van Dijkum, Els J. M.
AU - Vogt, Liffert
AU - Engelsman, Anton F.
AU - on behalf of the Dutch Hyperparathyroidism Study Group
AU - von Forstner, Philip
AU - Gispen, Carlijn
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Purpose: Calcimimetics are currently indicated for severe secondary hyperparathyroidism (SHPT). However, the role of parathyroidectomy (PTX) for these patients is still under debate, and its impact on subsequent kidney transplantation (KTX) is unclear. In this study, we compare the outcomes of kidney transplantation after PTX or medical treatment. Methods: Patients who underwent KTX and had SHPT were analyzed retrospectively. Two groups were selected (patients who had either PTX or calcimimetics prior to KTX) using a propensity score for sex, age, donor type, and parathyroid hormone levels (PTH) during dialysis. The primary outcome was graft failure, and secondary outcomes were surgical KTX complications, survival, serum PTH, serum calcium, and serum phosphate levels post-KTX. Results: Matching succeeded for 92 patients. After PTX, PTH was significantly lower on the day of KTX as well as at 1 and 3 years post-KTX (14.00 pmol/L (3.80–34.00) vs. 71.30 pmol/L (30.70–108.30), p < 0.01, 10.10 pmol/L (2.00–21.00) vs. 32.35 pmol/L (21.58–51.76), p < 0.01 and 13.00 pmol/L (6.00–16.60) vs. 19.25 pmol/L (13.03–31.88), p = 0.027, respectively). No significant differences in post-KTX calcium and phosphate levels were noted between groups. Severe KTX complications were more common in the calcimimetics group (56.5% vs. 30.4%, p = 0.047). There were no differences in 10-year graft failure and overall survival. Conclusion: PTX resulted in lower PTH after KTX in comparison to patients who received calcimimetics. Severe complications were more common after calcimimetics, but graft failure and overall survival were similar.
AB - Purpose: Calcimimetics are currently indicated for severe secondary hyperparathyroidism (SHPT). However, the role of parathyroidectomy (PTX) for these patients is still under debate, and its impact on subsequent kidney transplantation (KTX) is unclear. In this study, we compare the outcomes of kidney transplantation after PTX or medical treatment. Methods: Patients who underwent KTX and had SHPT were analyzed retrospectively. Two groups were selected (patients who had either PTX or calcimimetics prior to KTX) using a propensity score for sex, age, donor type, and parathyroid hormone levels (PTH) during dialysis. The primary outcome was graft failure, and secondary outcomes were surgical KTX complications, survival, serum PTH, serum calcium, and serum phosphate levels post-KTX. Results: Matching succeeded for 92 patients. After PTX, PTH was significantly lower on the day of KTX as well as at 1 and 3 years post-KTX (14.00 pmol/L (3.80–34.00) vs. 71.30 pmol/L (30.70–108.30), p < 0.01, 10.10 pmol/L (2.00–21.00) vs. 32.35 pmol/L (21.58–51.76), p < 0.01 and 13.00 pmol/L (6.00–16.60) vs. 19.25 pmol/L (13.03–31.88), p = 0.027, respectively). No significant differences in post-KTX calcium and phosphate levels were noted between groups. Severe KTX complications were more common in the calcimimetics group (56.5% vs. 30.4%, p = 0.047). There were no differences in 10-year graft failure and overall survival. Conclusion: PTX resulted in lower PTH after KTX in comparison to patients who received calcimimetics. Severe complications were more common after calcimimetics, but graft failure and overall survival were similar.
KW - Calcimimetics
KW - Kidney transplantation
KW - Parathyroidectomy
KW - Secondary hypersparathyroidism
UR - http://www.scopus.com/inward/record.url?scp=85089255472&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00423-020-01953-5
DO - https://doi.org/10.1007/s00423-020-01953-5
M3 - Article
C2 - 32778916
SN - 1435-2443
VL - 405
SP - 851
EP - 859
JO - Langenbeck s archives of surgery / Deutsche Gesellschaft fur Chirurgie
JF - Langenbeck s archives of surgery / Deutsche Gesellschaft fur Chirurgie
IS - 6
ER -