Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation

World J Surg. 2019 Aug;43(8):1972-1980. doi: 10.1007/s00268-019-04952-w.


Background: Parathyroidectomy (PTx) is the treatment of choice for end-stage renal disease (ESRD) patients with therapy-resistant hyperparathyroidism (HPT). The optimal timing of PTx for ESRD-related HPT-before or after kidney transplantation (KTx)-is subject of debate.

Methods: Patients with ESRD-related HPT who underwent both PTx and KTx between 1994 and 2015 were included in a multicenter retrospective study in four university hospitals. Two groups were formed according to treatment sequence: PTx before KTx (PTxKTx) and PTx after KTx (KTxPTx). Primary endpoint was renal function (eGFR, CKD-EPI) between both groups at several time points post-transplantation. Correlation between the timing of PTx and KTx and the course of eGFR was assessed using generalized estimating equations (GEE).

Results: The PTxKTx group consisted of 102 (55.1%) and the KTxPTx group of 83 (44.9%) patients. Recipient age, donor type, PTx type, and pre-KTx PTH levels were significantly different between groups. At 5 years after transplantation, eGFR was similar in the PTxKTx group (eGFR 44.5 ± 4.0 ml/min/1.73 m2) and KTxPTx group (40.0 ± 6.4 ml/min/1.73 m2, p = 0.43). The unadjusted GEE model showed that timing of PTx was not correlated with graft function over time (mean difference -1.0 ml/min/1.73 m2, 95% confidence interval -8.4 to 6.4, p = 0.79). Adjustment for potential confounders including recipient age and sex, various donor characteristics, PTx type, and PTH levels did not materially influence the results.

Conclusions: In this multicenter cohort study, timing of PTx before or after KTx does not independently impact graft function over time.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Allografts / physiology*
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Hyperparathyroidism / etiology
  • Hyperparathyroidism / surgery*
  • Kidney / physiology*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Parathyroidectomy*
  • Retrospective Studies
  • Time Factors