Parathyroidectomy is underused in patients with tertiary hyperparathyroidism after renal transplantation

Published:October 22, 2015DOI:


      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.


      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.


      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).


      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.
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        • Evenepoel P.
        • Claes K.
        • Kuypers D.
        • et al.
        Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study.
        Nephrol Dial Transplant. 2004; 19: 1281-1287
        • Pitt S.C.
        • Sippel R.S.
        • Chen H.
        Secondary and tertiary hyperparathyroidism, state of the art surgical management.
        Surg Clin North Am. 2009; 89: 1227-1239
        • Triponez F.
        • Clark O.H.
        • Vanrenthergem Y.
        • et al.
        Surgical treatment of persistent hyperparathyroidism after renal transplantation.
        Ann Surg. 2008; 248: 18-30
        • Triponez F.
        • Kebebew E.
        • Dosseh D.
        • et al.
        Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation.
        Surgery. 2006; 140: 990-997
        • Serra A.L.
        • Schwarz A.A.
        • Wick F.H.
        • et al.
        Successful treatment of hypercalcemia with cinacalcet in renal transplant recipients with persistent hyperparathyroidism.
        Nephrol Dial Transplant. 2005; 20: 1315-1319
        • Kruse A.E.
        • Eisenberger U.
        • Frey F.J.
        • et al.
        The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism.
        Nephrol Dial Transplant. 2005; 20: 1311-1314
      1. Food and Drug Administration. Full Prescribing Information, Sensipar (cinacalcet) [updated 2011 Aug 1; cited 2015 May 5]. Available from:

        • Somnay Y.R.
        • Weinlander E.
        • Schneider D.F.
        • et al.
        The effect of cinacalcet on intraoperative findings in tertiary hyperparathyroidism patients undergoing parathyroidectomy.
        Surgery. 2014; 156: 1308-1313
        • Goolsby M.J.
        National Kidney Foundation Guidelines for chronic kidney disease: evaluation, classification, and stratification.
        J Am Acad Nurse Pract. 2002; 14: 238-242
        • Eknoyan G.
        • Levin A.
        • Levin N.W.
        Bone metabolism and disease in chronic kidney disease.
        American Journal of Kidney Diseases. 2003; 42: S1-S201
      2. United States Renal Data System. 2014 Annual data report: Epidemiology of kidney disease in the United States. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda2014
        • Nichol P.F.
        • Starling J.R.
        • Mack E.
        • et al.
        Long-term follow-up of patients with tertiary hyperparathyroidism treated by resection of a single or double adenoma.
        Ann Surg. 2002; 235: 673-678
        • Lee P.P.
        • Schiffmann L.
        • Offermann G.
        • et al.
        Effects of parathyroidectomy on renal allograft survival.
        Kidney Blood Press Res. 2004; 27: 191-196
        • Schwarz A.
        • Rustien G.
        • Merkel S.
        • et al.
        Decreased renal transplant function after parathyroidectomy.
        Nephrol Dial Transplant. 2007; 22: 584-591
        • Kilgo M.S.
        • Pirsch J.D.
        • Warner T.F.
        • et al.
        Tertiary hyperparathyroidism after renal transplantation: surgical strategy.
        Surgery. 1998; 124: 677-683
        • Bhuriya R.
        • Li S.
        • Chen S.C.
        • et al.
        Plasma parathyroid hormone level and prevalent cardiovascular disease in CKD stages 3 and 4: an analysis from the Kidney Early Evaluation Program (KEEP).
        Am J Kidney Dis. 2009; 53: S3-S10