The Controversial Issue of Parathyroidectomy After Kidney Transplant.

Abstract

(Background) There have been some reports that parathyrodiectomy after kidney transplantation for tertiary hyperparathyroidism had a detrimental effect on graft function. However, there is no consensus on the criteria and method of parathyroidectomy after kidney transplantation. We attempted to illustrate the impact of parathryoidectomy on graft function. (Method) Among the kidney transplant patients, we analyzed 23 patients who underwent parathryoidectomy for tertiary hyperparathyroidism (group 1) from 1992 to 2012. And we selected 23 control group patients, matching sex and age, who did not have parathryoidectomy (group 2) during the same period. The comparative analysis was performed between the two groups. (Result) All the patients who had parathyroid operation had subtotal or total parathyroidectomy with autotransplantation. The mean number of remained parathyroid gland was 1.0±0.45. The preoperative mean calcium level was higher in group 1 than group 2 (10.7±0.6mg/dl vs. 9.0±0.9mg/dl, p<0.001). But, after parathyroidectomy the mean calcium levels were compatible between the two groups (9.2±0.7 vs. 9.2±0.6, p=0.98). After parathyroidectomy, parathyroid hormone was markedly decreased in group 1 (pre-parathyroidectomy: 394.2±286.2 pg/ml vs. post-parathryoidectomy: 83.5±40.8 pg/ml, p<0.001, reference value: 10˜65 pg/ml). After parathyroidectomy, the renal graft functions were well preserved contrary to the previous published reports (Fig 1). (Conclusion) The parathyroidectomy of tertiary pararthyroidism may not be a risk factor of graft function if careful selection of patients and operation procedures are possible.