Post Kidney Transplant Parathyroidectomy May Affect Graft Function

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DENVER—Post kidney transplant parathyroidectomy (PTx) may cause a transient decline in estimated glomerular filtration rate (eGFR) during the first few months but substantially improves to a level significantly superior to pre-PTx values, data show.

The impact of PTx on kidney transplant function is unclear. Worsening graft function in the presence of uncontrolled hyperparathyroidism is proposed as an indication for PTx.  Researchers at Ohio State University Medical Center in Columbus, conducted a retrospective study of 3,000 transplant recipients. Of these, 33 underwent PTx because of uncontrolled hyperparathyroidism. 

All patients were monitored for a change in eGFR for one year pre- and post- PTx. The researchers also looked at graft loss and mortality. The mean age of the patients was 49 years.

Samir Parikh, MD, and colleagues observed a significant decline in the first three months, with a mean eGFR slope of -3.0611/month compared with – 0.123853/month pre-PTx.  However, at one year, the researchers found the mean eGFR significantly improved with overall mean GFR slope of – 0.08515/month compared with mean GFR slope pre-PTx, a difference of -0.0438/month. 

Six patients (18%) lost their graft within 35 months of follow-up. No graft loss was reported during the first year and the causes of graft loss were rejection (two patients), reflux pyelonephritis (one patient), and chronic allograft nephropathy (three patients).  Three patients died within 12 months of PTx secondary to myocardial infarction (one patient), surgical complication (one patient), and sepsis (one patient).

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