title: Parathyroidectomy prior to kidney transplant decreases graft failure.
abstract: Uncorrected uremic hyperparathyroidism is associated with delayed graft function after kidney transplantation. The current guidelines of the Kidney Disease Improving Global Outcomes recommend maintaining parathyroid hormone ≤9x normal in patients pre-kidney transplantation. This study explores the effect of increased levels of serum parathyroid hormone and preoperative parathyroidectomy on outcomes after kidney transplantation.
  
  
  
  A retrospective review was performed of adult patients who underwent kidney transplantation between January 1, 2005, and December 31, 2014, at a single institution. Biochemistries and outcomes were analyzed pre-kidney transplantation and at 30 days, 6 months, and 1 year post-kidney transplantation.
  
  
  
  A total of 913 patients underwent kidney transplantation from 2005-2014. Graft survival 1 year post-kidney transplantation was 97.8%. Overall, 462 (50.6%) patients had a pre-kidney transplantation diagnosis of uncorrected uremic hyperparathyroidism, which was associated with complications in the first year post-kidney transplantation (odds ratio 1.44; 95% confidence interval, 1.11-1.87); no statistical association with delayed graft function or graft failure was detected. Pre-kidney transplantation parathyroid hormone ≥6x normal was associated with post-kidney transplantation graft failure (P < .05). A total of 57 (6.2%) patients underwent pre-kidney transplantation parathyroidectomy, which was associated with lesser risk of graft failure (odds ratio: 0.547; 95% confidence interval, 0.327-0.913), but no statistically significant association with delayed graft function or complications were detected.
  
  
  
  Pre-kidney transplantation parathyroidectomy decreases post-kidney transplantation graft failure and may benefit patients whose serum parathyroid hormone levels decrease into the target range of current Kidney Disease Improving Global Outcomes guidelines.
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT. Electronic address: glenda.callender@yale.edu.
authors.forename: Glenda G
authors.initials: GG
authors.lastname: Callender
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malinowski
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Javid
authors.affiliation: Department of Surgery, Section of Surgical Outcomes and Epidemiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Yawei
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Section of Surgical Outcomes and Epidemiology, Yale University School of Medicine, New Haven, CT.
authors.forename: Huang
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Quinn
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Tobias
authors.initials: T
authors.lastname: Carling
authors.affiliation: Department of Surgery, Section of Transplantation Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Tomlin
authors.affiliation: Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT.
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Smith
authors.affiliation: Department of Surgery, Section of Transplantation Surgery, Yale University School of Medicine, New Haven, CT.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kulkarni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone