title: Does the Parathyroidectomy Endanger the Transplanted Kidney?
abstract: BACKGROUND
  Some investigators maintain that a parathyroidectomy (PTX) performed for tertiary hyperparathyroidism may potentially cause graft malfunction or even loss of the transplanted kidney after the operation. The goal of this study was to determine if parathyroidectomy affects transplanted kidney function.
  
  
  METHODS
  The study group consisted of 48 renal graft recipients who underwent operation due to tertiary hyperparathyroidism. Thirty-nine subtotal parathyroidectomies and 9 more selective, less than subtotal parathyroidectomies were performed. The estimated glomerular filtration rate (eGFR) was calculated retrospectively on days 2 to 3 and 4 to 5 and at 1, 3, 6, 12, 24, and 36 months after PTX; these findings were compared with preoperative values. The cumulative graft survival rate in the postoperative period was assessed.
  
  
  RESULTS
  In the follow-up period, 4 of 48 patients returned to hemodialysis (after 1, 7, 22, and 57 months after PTX). In the first case, the patient had stopped taking the immunosuppressive drugs 1 month after PTX. Cumulative graft survival rate after PTX was 98.0% after 6 months, 96% after 12 months, and 93% after 2 and 3 years. The mean preoperative eGFR was 52 ± 17.15 mL/min/1.73 m(2), and the median was 48.28 mL/min/1.73 m(2). Overall and in the subtotal parathyroidectomy group, eGFR was significantly lower (P < .001) only on days 2 to 3. There were no differences between preoperative and postoperative eGFR values in the other follow-up periods. In the more selective, less than subtotal parathyroidectomy group, the decrease in eGFR values was nonsignificant compared with preoperative findings in the early postoperative period as well as in all follow-up periods.
  
  
  CONCLUSIONS
  In this study, PTX did not significantly impair transplanted kidney function, but in the early postoperative period, transient reductions in graft function did occur.
authors: Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland. Electronic address: witold.chudzinski@wum.edu.pl.
authors: W
authors: W
authors: Chudzinski
authors: Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
authors: M
authors: M
authors: Wyrzykowska
authors: Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
authors: S
authors: S
authors: Nazarewski
authors: Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors: M
authors: M
authors: Durlik
authors: Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland.
authors: Z
authors: Z
authors: Galazka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000503:physiopathology*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019737:Transplants / Q000503:physiopathology; D016896:Treatment Outcome