Introduction:Hyperparathyroidism(HPT) often persists after renal transplantation(Tx). Cinacalcet(Cx) and parathyroidectomy(PTx) are possible treatments. It was reported that PTx may be followed by a reduction in Tx function, raising the question whether it must be performed prior to Tx. In this retrospective study, we aimed to investigate the differences in several Tx outcome measures and in classical markers of bone homeostasis by comparing HPT patients who underwent PTx before Tx with patients whose HPT was managed medically.

Methods:130 Tx patients treated with Cx and 49 patients who underwent PTx before Tx were selected from our records over an 8-year period. We excluded patients with early (3 months) graft failure and a post-Tx follow up <6 months. The following 2-year post-Tx outcome measures were considered: graft failure, graft function (eGFR≥60mls/min), Tx artery stenosis requiring stenting within 12 months after Tx and rejection.

Results:117 and 46 patients were included in the Cx and PTx group respectively. PTH levels at the time of Tx were higher in the Cx vs PTx (72.3 vs 1.6,p<0.001). PTx was associated with significantly better bone profile markers (Ca 2.50 vs 2.36,p<0.001; Phos 0.85 vs 1.14,p<0.001; ALP 107 vs 80,p=0.004 at 24 months) during the study. No significant difference was found in rejection, renal artery stenosis and Tx failure rates between the two groups. The Cx group showed a better mean eGFR throughout the 24-month follow-up period (48.5±17.9 vs 39.9±17.8 at 24 months,p=0.015) compared to PTx group. This persisted after multivariant analysis (p=0.011). Investigating the hypothesis that such a finding could be explained by a longer HPT duration in the PTx group, we compared the latter with a subgroup of 48 patients who were already on Cx before Tx. The results were similar (p=0.015).

Conclusions:Tx patients with HPT who had PTx before Tx had significantly better bone profile markers up to 24 months after Tx compared with those treated with Cx. We observed better mean eGFR in the Cx compared to PTx group throughout the study. This may reflect the comorbidity of patients with more severe HPT in the PTx group since the difference in Tx function emerged in the first 3 months post-Tx and was due to causes such as infection and vascular complications. Further studies are required.

CITATION INFORMATION: Lucisano G, Charif R, Koutroutsos K, Taube D, Palazzo F, Loucaidou M. Cinacalcet Versus Pre-Transplant Parathyroidectomy in Renal Transplant Recipients: Single Centre Experience. Am J Transplant. 2016;16 (suppl 3).

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