*Purpose: Whether parathyroidectomy in ESRD patients should be performed before or after kidney transplant remains controversial. There is concern that post-transplant parathyroidectomy can adversely affect the renal allograft.

*Methods: We performed a retrospective review of 101 kidney transplant recipients at our center between 1/2012-2/2019 who had received parathyroidectomy either pre-transplant (n=23) or post-transplant (n=78). Comparisons were made using the t-test or paired t-test, as appropriate, and the Chi-square or Fisher’s Exact test for categorical variables.

*Results: Patients who had a pre-transplant parathyroidectomy were younger at the time of transplant, with a mean age 41.5 years (SD 11.8) vs 50 years (SD 11.3) (p=0.002). A greater proportion of females (56.5% vs 29.5%, p = 0.02) and African Americans (82.9% vs 60.26%, p= 0.05) comprised the pre- vs. post-transplant parathyroidectomy groups. There was no difference in dialysis vintage between pre vs post-transplant parathyroidectomy groups (mean 80.4 ± 43 months vs 81.6 ± 41.0 months) . Patients with pre-transplant parathyroidectomy had lower iPTH, calcium, phosphorous and alkaline phosphatase levels at time of transplant [mean iPTH 187.6 pg/mL ±237.4 vs 873.2 pg/ml ±808.4 (p=<0.001), mean calcium 8.82 mg/dL ±1.58 vs 9.89 mg/dl ±0.9 (p=0.002), mean phosphorus 4.23 mg/dL ±1.31 vs 5.41 mg/dl ± 1.50 (p=0.0004), mean ALP 93.2 ±57.7 vs 126.6 ±109.1 u/L. Post-transplant parathyroidectomy surgery corrected hyperparathyroidism and improved calcium and phosphorous levels [pre vs. post: iPTH 396.3 pg/ml vs 150.9 pg/ml (p<0.001) calcium 10.4 mg/dl vs 8.8 mg/dl (p=<0.001), phosphorus 3.3 mg/dl vs 2.8 mg/dl (p<0.001). Alkaline phosphatase levels were not significantly different pre and post parathyroidectomy 147 u/L vs 139.9 u/L (p = 0.07) . Mean creatinine pre-parathyroidectomy and mean 30-day creatinine post-parathyroidectomy was unchanged 1.72 vs 1.80 mg/dL (p = 0.21). Only 1 patient had acute rejection within 30 days post parathyroidectomy. No graft loss occurred within 1 year post-parathyroidectomy and there were no reported surgical complications. One-year patient survival was 98.7%; the one death that occurred was unrelated to PTX surgery.

*Conclusions: Parathyroidectomy post-transplant in our case series improves CKD-related mineral bone disorder. Renal allograft function was not adversely affected in the short term, and graft rejection shortly after parathyroidectomy was rare.

« Back to 2020 American Transplant Congress