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Comparison of Pre- and Post-transplant Parathyroidectomy in Renal Transplant Recipients and the Impact of Parathyroidectomy Timing on Calcium Metabolism and Renal Allograft Function: A Retrospective Single-Center Analysis

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Abstract

Background

The effect of parathyroidectomy (PTx) timing on serum calcium (Ca) levels and renal functions in renal transplant recipients with severe hyperparathyroidism (HPT) remains unclear. We retrospectively aimed to investigate and compare the clinical data of patients who underwent pre- and post-transplant PTx and elucidated the impact of PTx timing on serum Ca levels and renal graft outcomes after renal transplantation (RTx).

Methods

During January 2000–December 2016, 53 and 55 patients underwent post-transplant PTx (Post-RTx group) and pretransplant PTx (Pre-RTx group), respectively. The serum Ca levels and estimated glomerular filtration rate (eGFR) were assessed in both groups.

Results

At the end of the follow-up, the serum Ca levels were significantly higher and the incidence of hypocalcemia was significantly lower in the Pre-RTx group than in the Post-RTx group [9.5 vs. 8.9 mg/dL, P < 0.001; 14.5% vs. 34.0%, P = 0.024]. The decrease in the eGFR 12–36 months after RTx was more significant in the Post-RTx group than in the Pre-RTx group (−13.8% vs. −0.9%; P = 0.001). A logistic regression involving age, sex, dialysis period, and serum parathormone level revealed that post-transplant PTx is an independent risk factor for persistent hypocalcemia at the end of the follow-up (P = 0.034) and for a >20% decrease in the eGFR 12–36 months after RTx (P = 0.029).

Conclusions

In renal transplant candidates with severe HPT, pretransplant PTx should be considered to prevent persistent hypocalcemia and deterioration of the renal graft function.

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Acknowledgements

The authors thank Ms. Miho Miyazawa and Ms. Naoko Imai for valuable sample collection and Enago (www.enago.jp) for the English language review.

Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Transplantation and Endocrine Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 4668650, Japan

    Manabu Okada, Takahisa Hiramitsu, Toshihiro Ichimori, Norihiko Goto, Shunji Narumi, Yoshihiko Watarai & Yoshihiro Tominaga

  2. Department of General Internal Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    Tetsuhiko Sato

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  1. Manabu Okada
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  2. Takahisa Hiramitsu
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  3. Toshihiro Ichimori
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Correspondence to Manabu Okada.

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The study protocol was approved by the Institutional Review Board of Nagoya Daini Red Cross Hospital and was conducted according to the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in this study.

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This paper will be presented as an oral presentation at the IAES meeting/48th World Congress of Surgery August 11–15, 2019, in Kraków, Poland.

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Okada, M., Hiramitsu, T., Ichimori, T. et al. Comparison of Pre- and Post-transplant Parathyroidectomy in Renal Transplant Recipients and the Impact of Parathyroidectomy Timing on Calcium Metabolism and Renal Allograft Function: A Retrospective Single-Center Analysis. World J Surg 44, 498–507 (2020). https://doi.org/10.1007/s00268-019-05124-6

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