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Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation: a propensity-matched analysis

Dutch Hyperparathyroidism Study Group, Koh, E. Y., van der Plas, W. Y., Dulfer, R. R., Pol, R. A., Kruijf, S., Rotmans, J. I., Appelman-Dijkstra, N., Schepers, A., de Borst, M. H., Hoorn, E. J., van Ginhoven, T., Nieveen van Dijkum, E. J. M., Vogt, L. & Engelsman, A. F., Sep-2020, In : Langenbecks Archives of Surgery. 405, 6, p. 851-859 9 p.

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  • Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation a propensity-matched analysis

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DOI

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.

Original languageEnglish
Pages (from-to)851-859
Number of pages9
JournalLangenbecks Archives of Surgery
Volume405
Issue number6
Publication statusPublished - Sep-2020

    Keywords

  • Secondary hyperparathyroidism, Parathyroidectomy, Calcimimetics, Kidney transplantation, STAGE RENAL-DISEASE, CINACALCET HYDROCHLORIDE, CLASSIFICATION, MANAGEMENT, SURVIVAL, THERAPY

ID: 134702573