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Parathyroidectomy after Kidney Transplant is Associated with Increased Graft Failure
*Mahsa Javid, *Sanjay Kulkarni, *Courtney E. Quinn, *Tobias Carling, Glenda Callender
Yale University School of Medicine, New Haven, CT
Objective: To assess the effect of parathyroidectomy timing on kidney transplant (KTX) graft function in patients with uremic hyperparathyroidism (UHPT). It is known that the degree of parathyroid hormone (PTH) elevation prior to KTX is a risk factor for graft failure and predicts eventual development of tertiary HPT. However, the risk of graft failure in patients undergoing parathyroidectomy before KTX has not been compared with that of patients undergoing parathyroidectomy after KTX. Design: Retrospective cohort study Setting: Tertiary care academic center Patients:Adult patients who underwent KTX between 1/1/2005-12/31/2014 Interventions:Pre-KTX parathyroidectomy; post-KTX parathyroidectomy Main outcome measures:Graft failure Results:913 patients underwent KTX from 2005-2014. Median age was 53 (range 18-83) years. Most patients were white (59.4%) and male (65.2%). Graft survival 1 year post-KTX was 97.8%. Overall, 462 (50.6%) patients had a pre-KTX diagnosis of UHPT. Of these, 57 (12.3%) underwent parathyroidectomy at median 2.2 (range 0.1-25.1) years pre-KTX, and 18 (3.9%) patients underwent parathyroidectomy at median 2 (range 0.2-7.8) years post-KTX for tertiary HPT. Overall graft failure in patients who underwent post-KTX parathyroidectomy was significantly higher than in patients who never underwent parathyroidectomy or who underwent parathyroidectomy pre-KTX (39% vs 7% vs 13%; p=0.0003, p=0.0341, respectively). Graft failure was not statistically different between patients who never underwent parathyroidectomy versus patients who underwent pre-KTX parathyroidectomy (p=NS). Conclusions: Patients who undergo parathyroidectomy after KTX appear to be at increased risk of graft failure. The timing of parathyroidectomy appears to be an important factor in graft survival after KTX. Consideration of parathyroidectomy prior to KTX to reduce PTH levels and prevent development of tertiary HPT may lead to improved graft survival in this patient population.
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