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).
Conclusion
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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Article Info
Publication History
Published online: October 22, 2015
Accepted:
August 3,
2015
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
