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Impact of parathyroidectomy on kidney graft function in post-transplant tertiary hyperparathyroidism: a comparative study

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Abstract

Purpose

Parathyroidectomy to treat tertiary hyperparathyroidism (THPT) is now on a par with calcimimetic treatment. The effects of cinacalcet and parathyroidectomy on kidney transplant function remain controversial. The aim of this study was to evaluate kidney transplant function in THPT patients treated either by parathyroidectomy, cinacalcet, or not treated.

Methods

Between 2009 and 2019, 231 patients with functional grafts presenting THPT, defined either by calcaemia superior to 2.5 mmol/L with elevated PTH level or hypercalcaemia with non-adapted PTH level 1 year after kidney transplantation, were included. Hyperparathyroid patients treated by cinacalcet and parathyroidectomy were matched for age, sex, graft rank, and baseline eGFR with cinacalcet-only and untreated patients. Conditional logistic regression models were used to compare eGFR variations 1 year after parathyroidectomy between operated patients and matched controls. Five-year survivals were compared with the Mantel-Cox test.

Results

Eleven patients treated with parathyroidectomy and cinacalcet were matched with 16 patients treated by cinacalcet-only and 29 untreated patients. Demographic characteristics were comparable between groups. Estimated odds ratios for eGFR evolution in operated patients compared with cinacalcet-only and untreated patients were 0.92 [95%CI 0.83–1.02] and 0.99 [0.89–1.10] respectively, indicating no significant impairment of eGFR 1 year after surgery. Five-year allograft survival was not significantly impaired in operated patients.

Conclusions

Parathyroidectomy did not appear to substantially alter or improve graft function 1 year after surgery or 5-year allograft survival. It could be hypothesized that in addition to its known benefits, parathyroidectomy can be safely performed vis-à-vis graft function in tertiary hyperparathyroidism.

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Acknowledgements

DIVAT consortium: Gilles Blancho, Julien Branchereau, Diego Cantarovich, Agnès Chapelet, Jacques Dantal, Clément Deltombe, Lucile Figueres, Claire Garandeau, Magali Giral, Caroline Gourraud-Vercel, Maryvonne Hourmant, Georges Karam, Clarisse Kerleau, Aurélie Meurette, Simon Ville, Christine Kandell, Anne Moreau, Karine Renaudin, Anne Cesbron, Florent Delbos, Alexandre Walencik, Anne Devis, Lucile Amrouche, Dany Anglicheau, Olivier Aubert, Lynda Bererhi, Christophe Legendre, Alexandre Loupy, Frank Martinez, Rébecca Sberro-Soussan, Anne Scemla, Claire Tinel, Julien Zuber, Pascal Eschwege, Luc Frimat, Sophie Girerd, Jacques Hubert, Marc Ladriere, Emmanuelle Laurain, Louis Leblanc, Pierre Lecoanet, Jean-Louis Lemelle, Lionel Badet, Maria Brunet, Fanny Buron, Rémi Cahen, Sameh Daoud, Coralie Fournie, Arnaud Grégoire, Alice Koenig, Charlène Lévi, Emmanuel Morelon, Claire Pouteil-Noble, Thomas Rimmelé, Olivier Thaunat, Sylvie Delmas, Valérie Garrigue, Moglie Le Quintrec, Vincent Pernin, Jean-Emmanuel Serre.

Author information

Authors and Affiliations

  1. Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L’Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France

    Samuel Frey, Claire Blanchard, Cécile Caillard & Éric Mirallié

  2. Université de Nantes, quai de Tourville, 44000, Nantes, France

    Samuel Frey, Claire Blanchard, Pierre-Antoine Gourraud, Maryvonne Hourmant, Lucile Figueres & Éric Mirallié

  3. L’institut du Thorax, Unité Inserm UMR 1087 / CNRS UMR 6291, IRS 8 Quai Moncousu, 44000, Nantes, France

    Samuel Frey & Claire Blanchard

  4. CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France

    Thomas Goronflot, Pierre-Antoine Gourraud & Matthieu Wargny

  5. Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France

    Clarisse Kerleau, Maryvonne Hourmant & Lucile Figueres

  6. Service de Néphrologie-Immunologie Clinique, CHU de Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France

    Maryvonne Hourmant & Lucile Figueres

Authors
  1. Samuel Frey
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  2. Thomas Goronflot
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  3. Claire Blanchard
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  4. Clarisse Kerleau
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  5. Pierre-Antoine Gourraud
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  6. Matthieu Wargny
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  7. Cécile Caillard
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  8. Maryvonne Hourmant
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  9. Lucile Figueres
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  10. Éric Mirallié
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Consortia

DIVAT Consortium

  • Gilles Blancho
  • , Julien Branchereau
  • , Diego Cantarovich
  • , Agnès Chapelet
  • , Jacques Dantal
  • , Clément Deltombe
  • , Lucile Figueres
  • , Claire Garandeau
  • , Magali Giral
  • , Caroline Gourraud-Vercel
  • , Maryvonne Hourmant
  • , Georges Karam
  • , Clarisse Kerleau
  • , Aurélie Meurette
  • , Simon Ville
  • , Christine Kandell
  • , Anne Moreau
  • , Karine Renaudin
  • , Anne Cesbron
  • , Florent Delbos
  • , Alexandre Walencik
  • , Anne Devis
  • , Lucile Amrouche
  • , Dany Anglicheau
  • , Olivier Aubert
  • , Lynda Bererhi
  • , Christophe Legendre
  • , Alexandre Loupy
  • , Frank Martinez
  • , Rébecca Sberro-Soussan
  • , Anne Scemla
  • , Claire Tinel
  • , Julien Zuber
  • , Pascal Eschwege
  • , Luc Frimat
  • , Sophie Girerd
  • , Jacques Hubert
  • , Marc Ladriere
  • , Emmanuelle Laurain
  • , Louis Leblanc
  • , Pierre Lecoanet
  • , Jean-Louis Lemelle
  • , Lionel Badet
  • , Maria Brunet
  • , Fanny Buron
  • , Rémi Cahen
  • , Sameh Daoud
  • , Coralie Fournie
  • , Arnaud Grégoire
  • , Alice Koenig
  • , Charlène Lévi
  • , Emmanuel Morelon
  • , Claire Pouteil-Noble
  • , Thomas Rimmelé
  • , Olivier Thaunat
  • , Sylvie Delmas
  • , Valérie Garrigue
  • , Moglie Le Quintrec
  • , Vincent Pernin
  •  & Jean-Emmanuel Serre

Contributions

Samuel Frey, Lucile Figueres, and Éric Mirallié participated in study conception, drafting of manuscript, and critical revision of manuscript. Thomas Goronflot, Matthieu Wargny, and Pierre-Antoine Gourraud made the statistical analysis and participated in the acquisition and interpretation of data. Clarisse Kerleau, Claire Blanchard, Cécile Caillard, and Maryvonne Hourmant participated in acquisition of data and critical revision of manuscript.

Corresponding author

Correspondence to Éric Mirallié.

Ethics declarations

Ethics approval

The French DIVAT cohort was approved by the CNIL, n°914184.

Consent to participate

All participants gave informed consent.

Consent for publication

All authors approved the last version of the manuscript and gave their consent for publication.

Conflict of interest

PA Gourraud is the founder (2008) (www.methodomics.com) and the co-founder of Wedata (2018) (www.wedata.science). He is consulting for major pharmaceuticals companies all dealt with through academic pipelines (AstraZeneca, Biogen, Boston Scientific, Cook, Edimark, Ellipses, Elsevier, Methodomics, Merck, Mérieux, Sanofi-Genzyme, WeData). He has no prescription activity neither drugs nor devices. The other authors have no conflicts of interest to disclose.

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Frey, S., Goronflot, T., Blanchard, C. et al. Impact of parathyroidectomy on kidney graft function in post-transplant tertiary hyperparathyroidism: a comparative study. Langenbecks Arch Surg 407, 2489–2498 (2022). https://doi.org/10.1007/s00423-022-02555-z

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