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Characteristics of Persistent Hyperparathyroidism After Renal Transplantation

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Abstract

Background

Persistent hyperparathyroidism (HPT) after renal transplantation (RTx), termed tertiary HPT (THPT), is not uncommon. However, risk factors and appropriate operative procedures for THPT are poorly understood.

Methods

A retrospective study of patients who underwent RTx without pre-transplant parathyroidectomy (PTx) was performed at our hospital between January 2001 and March 2011. Risk factors for the development of THPT were investigated by comparing THPT and non-THPT groups. We retrospectively analyzed patients with THPT who underwent total PTx with forearm autograft. Pre- and postoperative (1 year after PTx) laboratory results were analyzed for PTx efficacy.

Results

Data for 520 patients were analyzed. On multivariate analysis, long dialysis duration (p = 0.009, hazard ratio (HR) 1.01), large maximum parathyroid gland size before RTx (p = 0.003, HR 1.23), pre-RTx high intact parathyroid hormone (iPTH) (p = 0.041, HR 1.01), post-RTx (<2 weeks) high calcium (Ca) (p < 0.001, HR 25.04), and post-RTx high alkaline phosphatase (ALP) (p = 0.027, HR 0.99) were identified as risk factors for THPT. Patients who underwent PTx showed significant improvement compared with baseline for serum Ca, phosphorus, iPTH, and ALP. Serum creatinine showed no significant difference.

Conclusions

Several risk factors for THPT development were identified. PTx for patients with THPT significantly improved serum Ca, iPTH, ALP, and phosphorous levels. There was no significant difference in renal function after PTx. Therefore, total PTx with forearm autograft may be an appropriate surgical approach for patients with THPT.

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Abbreviations

HPT:

Hyperparathyroidism

RTx:

Renal transplantation

THPT:

Tertiary HPT

Ca:

Calcium

ALP:

Alkaline phosphatase

PTH:

Parathyroid hormone

SHPT:

Secondary HPT

PTx:

Parathyroidectomy

BMD:

Bone mineral density

BMI:

Body mass index

P:

Phosphorus

iPTH:

Intact PTH

Cre:

Creatinine

SD:

Standard deviation

HR:

Hazard ratio

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Acknowledgments

We thank Ms. Mitoko Imai, Ms. Mayumi Nobata, and Ms. Sayoko Ito of the Nagoya Daini Red Cross Hospital for their help with sample and data collection.

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Authors and Affiliations

  1. Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myouken Chou Showa Ku, Nagoya, Aichi, Japan

    Takayuki Yamamoto, Yoshihiro Tominaga, Manabu Okada, Takahisa Hiramitsu, Makoto Tsujita, Norihiko Goto, Shunji Narumi & Yoshihiko Watarai

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  1. Takayuki Yamamoto
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  2. Yoshihiro Tominaga
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  3. Manabu Okada
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  4. Takahisa Hiramitsu
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  5. Makoto Tsujita
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  6. Norihiko Goto
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  7. Shunji Narumi
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  8. Yoshihiko Watarai
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Correspondence to Takayuki Yamamoto.

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Yamamoto, T., Tominaga, Y., Okada, M. et al. Characteristics of Persistent Hyperparathyroidism After Renal Transplantation. World J Surg 40, 600–606 (2016). https://doi.org/10.1007/s00268-015-3314-z

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  • DOI: https://doi.org/10.1007/s00268-015-3314-z

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