title: Parathyroidectomy is underused in patients with tertiary hyperparathyroidism after renal transplantation.
abstract: BACKGROUND
  Parathyroidectomy (PTX) is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), PTX can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of PTX in patients with posttransplant 3HPT with the advent of cinacalcet.
  
  
  METHODS
  We evaluated renal transplant patients between January 1, 2004, and June 30, 2012, with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) at 1 year after successful renal transplantation with normocalcemia or hypercalcemia were defined as having 3HPT. A multivariate logistic regression model was constructed to determine factors associated with undergoing PTX.
  
  
  RESULTS
  We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent PTX. Patients with higher levels of serum calcium (P < .001) and PTH (P = .002) posttransplant were more likely to be referred for PTX. Importantly, those who underwent PTX had serum calcium and PTH values distributed more closely to the normal range on most recent follow-up. PTX was not associated with rejection (P = .400) or with worsened allograft function (P = .163).
  
  
  CONCLUSIONS
  PTX seems to be underused in patients with 3HPT at our institution. PTX is associated with high cure rates, improved serum calcium and PTH levels, and is not associated with rejection.
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Irene
authors.initials: I
authors.lastname: Lou
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Glen
authors.initials: G
authors.lastname: Leverson
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: David
authors.initials: D
authors.lastname: Foley
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Sippel
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, WI. Electronic address: herbchen@uab.edu.
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D000328:Adult; D001565:Benzoates / Q000627:therapeutic use; D057966:Calcimimetic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy
chemical_list: D001565:Benzoates; D057966:Calcimimetic Agents; C480588:BAY 58-2667