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Making the Cut: Parathyroidectomy Before or After Kidney Transplantation?

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Abstract

Background

Hyperparathyroidism is common in patients with end-stage kidney disease and may persist after kidney transplantation (KT). Parathyroidectomy (PTx) is curative, but whether PTx should be performed before or after KT remains controversial. There is concern that PTx can adversely affect renal allograft function if performed post-KT and result in persistent hypocalcemia. This study evaluated outcomes and postoperative complications of PTx before and after KT at our institution.

Methods

We performed a retrospective review of patients at our center (1/2012–2/2019) who had PTx either pre-KT or post-KT. Data on patient demographics, surgical outcomes, and postoperative complications of PTx were collected.

Results

Ninety-eight patients were included in this study, with 23 patients undergoing PTx before KT and 75 after KT. The length of follow-up after KT was 67.7 ± 25.5 months. In post-KT PTx patients, 30-day allograft function was unchanged after PTx. Calcium oxalate and phosphate crystals were less common on allograft biopsies in pre-KT PTx patients (10.0% vs. 34.8%, p = 0.038). Patients in the pre-KT group required more calcium supplementation after PTx than the post-KT group (p < 0.001). At one-year post-PTx, 17 (19.1%) patients required > 1000 mg elemental calcium per day and 7 (7.9%) patients required > 2000 mg/day. There was no difference in surgical success or postoperative complications between the two groups.

Conclusions

Parathyroidectomy before or after kidney transplantation does not adversely affect allograft function. The incidence of persistent hypocalcemia was low. Parathyroidectomy is safe and effective either before or after kidney transplantation.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Surgery, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL, 35233, USA

    Rongzhi Wang, M. Chandler McLeod, Jayme E. Locke & Herbert Chen

  2. School of Medicine, The University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, USA

    Faaiz Saad

  3. Department of Medicine, The University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL, 35233, USA

    Clifton Kew, Gaurav Agarwal, Keith Wille & Song Ong

Authors
  1. Rongzhi Wang
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  2. Faaiz Saad
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  7. Jayme E. Locke
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  8. Herbert Chen
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  9. Song Ong
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Corresponding author

Correspondence to Song Ong.

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The authors declare that they have no conflict of interest.

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The study has been approved by the Institutional Review Board at the University of Alabama at Birmingham.

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Accepted by the International Association of the International Society of Surgery at the 49th World Congress of Surgery, Vienna, Austria, August 15–18, 2022, Podium Presentation.

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Wang, R., Saad, F., McLeod, M.C. et al. Making the Cut: Parathyroidectomy Before or After Kidney Transplantation?. World J Surg 47, 319–329 (2023). https://doi.org/10.1007/s00268-022-06757-w

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