Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation: a prope
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ORIGINAL ARTICLE
Outcomes of parathyroidectomy versus calcimimetics for secondary hyperparathyroidism and kidney transplantation: a propensity-matched analysis Ezra Y. Koh 1 & Willemijn Y. van der Plas 2 & Roderick R. Dulfer 3 & Robert A. Pol 2 & Schelto Kruijf 2 & Joris I. Rotmans 4 & Natasha Appelman-Dijkstra 4 & Abbey Schepers 5 & Martin H. de Borst 6 & Ewout J. Hoorn 7 & Tessa van Ginhoven 3 & Els J. M. Nieveen van Dijkum 1 & Liffert Vogt 8 & Anton F. Engelsman 1 & on behalf of the Dutch Hyperparathyroidism Study Group Received: 31 March 2020 / Accepted: 28 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Calcimimetics are currently indicated for severe secondary hyperparathyroidism (SHPT). However, the role of parathyroidectomy (PTX) for these patients is still under debate, and its impact on subsequent kidney transplantation (KTX) is unclear. In this study, we compare the outcomes of kidney transplantation after PTX or medical treatment. Methods Patients who underwent KTX and had SHPT were analyzed retrospectively. Two groups were selected (patients who had either PTX or calcimimetics prior to KTX) using a propensity score for sex, age, donor type, and parathyroid hormone levels (PTH) during dialysis. The primary outcome was graft failure, and secondary outcomes were surgical KTX complications, survival, serum PTH, serum calcium, and serum phosphate levels post-KTX. Results Matching succeeded for 92 patients. After PTX, PTH was significantly lower on the day of KTX as well as at 1 and 3 years post-KTX (14.00 pmol/L (3.80–34.00) vs. 71.30 pmol/L (30.70–108.30), p < 0.01, 10.10 pmol/L (2.00–21.00) vs. 32.35 pmol/L (21.58–51.76), p < 0.01 and 13.00 pmol/L (6.00–16.60) vs. 19.25 pmol/L (13.03–31.88), p = 0.027, respectively). No significant differences in post-KTX calcium and phosphate levels were noted between groups. Severe KTX complications were more common in the calcimimetics group (56.5% vs. 30.4%, p = 0.047). There were no differences in 10-year graft failure and overall survival. Conclusion PTX resulted in lower PTH after KTX in comparison to patients who received calcimimetics. Severe complications were more common after calcimimetics, but graft failure and overall survival were similar. Keywords Secondary hyperparathyroidism . Parathyroidectomy . Calcimimetics . Kidney transplantation
Presented as an oral presentation at the International Association of Endocrine Surgeons 2017 Meeting * Anton F. Engelsman [email protected]
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Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, Netherlands
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Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 AZ Amsterdam, The Netherlands
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Department of Nephrology, Groningen University Medical Center, University of Groningen, Groningen, Netherlands
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Department of Surgery, Groningen University Medical Center, University of Groningen, Groningen, Netherlands
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Department of Nephrology, Erasmus Medical Center, Erasmus University Rotterdam, Rotte
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