Parathyroidectomy prior to kidney transplant decreases graft failure

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• 作者：Glenda G. Callender ; MD^a ; ^{glenda.callender@yale.edu} ; Jennifer Malinowski ; PhD^a ; Mahsa Javid ; MD ; DPhil^a ; Yawei Zhang ; MD ; PhD ; MPH^b ; Huang Huang ; MPH^b ; Courtney E. Quinn ; MD ; MS^a ; Tobias Carling ; MD ; PhD^a ; Ricarda Tomlin ; BS^c ; J. Douglas Smith ; MD^d ; Sanjay Kulkarni ; MD^c
• 刊名：Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：161
• 期：1
• 页码：44-50
• 全文大小：163 K
• 卷排序：161

文摘

Uncorrected uremic hyperparathyroidism is associated with delayed graft function after kidney transplantation. The current guidelines of the Kidney Disease Improving Global Outcomes recommend maintaining parathyroid hormone ≤9x normal in patients pre–kidney transplantation. This study explores the effect of increased levels of serum parathyroid hormone and preoperative parathyroidectomy on outcomes after kidney transplantation.MethodsA retrospective review was performed of adult patients who underwent kidney transplantation between January 1, 2005, and December 31, 2014, at a single institution. Biochemistries and outcomes were analyzed pre–kidney transplantation and at 30 days, 6 months, and 1 year post–kidney transplantation.ResultsA total of 913 patients underwent kidney transplantation from 2005–2014. Graft survival 1 year post–kidney transplantation was 97.8%. Overall, 462 (50.6%) patients had a pre–kidney transplantation diagnosis of uncorrected uremic hyperparathyroidism, which was associated with complications in the first year post–kidney transplantation (odds ratio 1.44; 95% confidence interval, 1.11–1.87); no statistical association with delayed graft function or graft failure was detected. Pre–kidney transplantation parathyroid hormone ≥6x normal was associated with post–kidney transplantation graft failure (P < .05). A total of 57 (6.2%) patients underwent pre–kidney transplantation parathyroidectomy, which was associated with lesser risk of graft failure (odds ratio: 0.547; 95% confidence interval, 0.327–0.913), but no statistically significant association with delayed graft function or complications were detected.ConclusionPre–kidney transplantation parathyroidectomy decreases post–kidney transplantation graft failure and may benefit patients whose serum parathyroid hormone levels decrease into the target range of current Kidney Disease Improving Global Outcomes guidelines.