Post-kidney transplant hyperparathyroidism: Current solutions and strategies?
Main Article Content
Abstract
Kidney transplantation remains the best treatment for patients with end-stage kidney disease, and it could partially mitigate systemic disorders of mineral and bone metabolism caused by secondary hyperparathyroidism. However, persistent hyperparathyroidism is still observed in 30- 60% of patients 1 year after kidney transplantation, leading to impairment of allograft function and a disturbance of mineral metabolism. The timing of parathyroidectomy varies among transplant centers because the possible negative effects of parathyroidectomy on allograft outcomes are still unclear. This review provides a comprehensive and detailed overview of the natural course of hyperparathyroidism following kidney transplantation and the effects of the timing and extent of parathyroidectomy on allograft function. It aims to provide useful information for surgeons to propose an appropriate intervention strategy to break the vicious cycle of post-kidney transplantation hyperparathyroidism and deterioration of allograft function.
Article Details
Keywords
hyperparathyroidism, parathyroid, secondary hyperparathyroidism
References
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2. Oruc A, Ersoy A, Yildiz A, Oz Gul O, Ersoy C. Effect of parathyroidectomy timing in kidney transplant recipients on graft function. Exp Clin Transplant. 2021; 19:316-323.
3. Jeon HJ, Kim YJ, Kwon HY, Koo TY, Baek SH, Kim HJ, Huh WS, Huh KH, Kim MS, Kim YS, Park SK, Ahn C, Yang J. Impact of parathyroidectomy on allograft outcomes in kidney transplantation. Transpl Int. 2012; 25:1248-1256.
4. Littbarski SA, Kaltenborn A, Gwiasda J, Beneke J, Arelin V, Schwager Y, Stupak JV, Marcheel IL, Emmanouilidis N, Jäger MD, Scheumann GFW, Klempnauer J, Schrem H. Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathyroidism: Effect of pretransplant versus early or late post-transplant parathyroidectomy. Surgery. 2018; 163:373-380.
5. Plas W, Moumni ME, Forstner P, et al. Timing of parathyroidectomy does not influence renal function after kidney transplantation. World J Surg. 2019; 43:1972-1980.
6. Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H. Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol. 1997; 13:78-86.
7. Isakov O, Ghinea R, Beckerman P, Mor E, Riella LV, Hod T. Early persistent hyperparathyroidism post-renal transplantation as a predictor of worse graft function and mortality after transplantation. Clin Transplant. 2020; 34:e14085.
8. Van Beek DJ, Fredriksson S, Haegele S, Raffaelli M, Riss P, Almquist M. Use of intraoperative parathyroid hormone measurements during parathyroidectomy to predict postoperative parathyroid hormone levels in patients with renal hyperparathyroidism: Meta-analysis. BJS Open. 2022; 6:zrab151.