title: Impact of post-kidney transplant parathyroidectomy on allograft function.
abstract: BACKGROUND
  The impact of parathyroidectomy on allograft function in kidney transplant patients is unclear.
  
  
  METHODS
  We conducted a retrospective, observational study of all kidney transplant recipients from 1988 to 2008 who underwent parathyroidectomy for uncontrolled hyperparathyroidism (n = 32). Post-parathyroidectomy, changes in estimated glomerular filtration rate (eGFR) and graft loss were recorded. Cross-sectional associations at baseline between eGFR and serum calcium, phosphate, and parathyroid hormone (PTH), and associations between their changes within subjects during the first two months post-parathyroidectomy were assessed.
  
  
  RESULTS
  Post-parathyroidectomy, the mean eGFR declined from 51.19 mL/min/1.73 m(2) at parathyroidectomy to 44.78 mL/min/1.73 m(2) at two months (p < 0.0001). Subsequently, graft function improved, and by 12 months, mean eGFR recovered to 49.76 mL/min/1.73 m(2) (p = 0.035). Decrease in serum PTH was accompanied by a decrease in eGFR (p = 0.0127) in the first two months post-parathyroidectomy. Patients whose eGFR declined by ≥20% (group 1) in the first two months post-parathyroidectomy were distinguished from the patients whose eGFR declined by <20% (group 2). The two groups were similar except that group 1 had a higher baseline mean serum PTH compared with group 2, although not significant (1046.7 ± 1034.2 vs. 476.6 ± 444.9, p = 0.14). In group 1, eGFR declined at an average rate of 32% (p < 0.0001) during the first month post-parathyroidectomy compared with 7% (p = 0.1399) in group 2, and the difference between these two groups was significant (p = 0.0003). The graft function recovered in both groups by one yr. During median follow-up of 66.00 ± 49.45 months, 6 (18%) patients lost their graft with a mean time to graft loss from parathyroidectomy of 37.2 ± 21.6 months. The causes of graft loss were rejection (n = 2), pyelonephritis (n = 1) and chronic allograft nephropathy (n = 3). No graft loss occurred during the first-year post-surgery.
  
  
  CONCLUSIONS
  Parathyroidectomy may lead to transient kidney allograft dysfunction with eventual recovery of graft function by 12 months post-parathyroidectomy. Higher level of serum PTH pre-parathyoidectomy is associated with a more profound decrease in eGFR post-parathyroidectomy.
authors: Division of Nephrology, Department of Internal Medicine, The Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors: Samir
authors: S
authors: Parikh
authors: Haikady
authors: H
authors: Nagaraja
authors: Anil
authors: A
authors: Agarwal
authors: Srinivas
authors: S
authors: Samavedi
authors: Jon
authors: J
authors: Von Visger
authors: Uday
authors: U
authors: Nori
authors: Kenneth
authors: K
authors: Andreoni
authors: Todd
authors: T
authors: Pesavento
authors: Neeraj
authors: N
authors: Singh
mesh_terms: D064591:Allografts; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010281:Parathyroid Hormone