TY - JOUR
T1 - Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation
AU - The Dutch Hyperparathyroidism Study Group
AU - van der Plas, Willemijn Y.
AU - el Moumni, Mostafa
AU - von Forstner, Philipp J.
AU - Koh, Ezra Y.
AU - Dulfer, Roderick R.
AU - van Ginhoven, Tessa M.
AU - Rotmans, Joris I.
AU - Appelman-Dijkstra, Natasha M.
AU - Schepers, Abbey
AU - Hoorn, Ewout J.
AU - Plukker, John Th. M.
AU - Vogt, Liffert
AU - Engelsman, Anton F.
AU - Nieveen van Dijkum, Els J. M.
AU - Kruijff, Schelto
AU - Pol, Robert A.
AU - de Borst, Martin H.
AU - Dutch Hyperparathyroidism Study Group
PY - 2019/8/15
Y1 - 2019/8/15
N2 - Background: Parathyroidectomy (PTx) is the treatment of choice for end-stage renal disease (ESRD) patients with therapy-resistant hyperparathyroidism (HPT). The optimal timing of PTx for ESRD-related HPT—before or after kidney transplantation (KTx)—is subject of debate. Methods: Patients with ESRD-related HPT who underwent both PTx and KTx between 1994 and 2015 were included in a multicenter retrospective study in four university hospitals. Two groups were formed according to treatment sequence: PTx before KTx (PTxKTx) and PTx after KTx (KTxPTx). Primary endpoint was renal function (eGFR, CKD-EPI) between both groups at several time points post-transplantation. Correlation between the timing of PTx and KTx and the course of eGFR was assessed using generalized estimating equations (GEE). Results: The PTxKTx group consisted of 102 (55.1%) and the KTxPTx group of 83 (44.9%) patients. Recipient age, donor type, PTx type, and pre-KTx PTH levels were significantly different between groups. At 5 years after transplantation, eGFR was similar in the PTxKTx group (eGFR 44.5 ± 4.0 ml/min/1.73 m2) and KTxPTx group (40.0 ± 6.4 ml/min/1.73 m2, p = 0.43). The unadjusted GEE model showed that timing of PTx was not correlated with graft function over time (mean difference −1.0 ml/min/1.73 m2, 95% confidence interval −8.4 to 6.4, p = 0.79). Adjustment for potential confounders including recipient age and sex, various donor characteristics, PTx type, and PTH levels did not materially influence the results. Conclusions: In this multicenter cohort study, timing of PTx before or after KTx does not independently impact graft function over time.
AB - Background: Parathyroidectomy (PTx) is the treatment of choice for end-stage renal disease (ESRD) patients with therapy-resistant hyperparathyroidism (HPT). The optimal timing of PTx for ESRD-related HPT—before or after kidney transplantation (KTx)—is subject of debate. Methods: Patients with ESRD-related HPT who underwent both PTx and KTx between 1994 and 2015 were included in a multicenter retrospective study in four university hospitals. Two groups were formed according to treatment sequence: PTx before KTx (PTxKTx) and PTx after KTx (KTxPTx). Primary endpoint was renal function (eGFR, CKD-EPI) between both groups at several time points post-transplantation. Correlation between the timing of PTx and KTx and the course of eGFR was assessed using generalized estimating equations (GEE). Results: The PTxKTx group consisted of 102 (55.1%) and the KTxPTx group of 83 (44.9%) patients. Recipient age, donor type, PTx type, and pre-KTx PTH levels were significantly different between groups. At 5 years after transplantation, eGFR was similar in the PTxKTx group (eGFR 44.5 ± 4.0 ml/min/1.73 m2) and KTxPTx group (40.0 ± 6.4 ml/min/1.73 m2, p = 0.43). The unadjusted GEE model showed that timing of PTx was not correlated with graft function over time (mean difference −1.0 ml/min/1.73 m2, 95% confidence interval −8.4 to 6.4, p = 0.79). Adjustment for potential confounders including recipient age and sex, various donor characteristics, PTx type, and PTH levels did not materially influence the results. Conclusions: In this multicenter cohort study, timing of PTx before or after KTx does not independently impact graft function over time.
KW - Adult
KW - Allografts/physiology
KW - Female
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Hyperparathyroidism/etiology
KW - Kidney Failure, Chronic/complications
KW - Kidney Transplantation
KW - Kidney/physiology
KW - Male
KW - Middle Aged
KW - Parathyroidectomy
KW - Retrospective Studies
KW - Time Factors
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85062019443&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30798418
U2 - https://doi.org/10.1007/s00268-019-04952-w
DO - https://doi.org/10.1007/s00268-019-04952-w
M3 - Article
C2 - 30798418
SN - 0364-2313
VL - 43
SP - 1972
EP - 1980
JO - World journal of surgery
JF - World journal of surgery
IS - 8
ER -