*Purpose: Secondary hyperparathyroidism (HPT) gradually resolves after successful kidney transplantation (KT), and parathyroidectomy (PTX) is reserved for patients whose HPT persists longer than a year after KT. Few reports have examined the role of PTX within the first year of transplant. In this case series, we describe our experience with early PTX as treatment for post-transplant HPT that failed medical therapy.

*Methods: Between August 2015 and December 2019, we identified 12 patients who underwent PTX within a year of KT. PTX was considered if HPT persisted despite treatment with the maximal tolerated dose of cinacalcet. Demographic and clinical characteristics were summarized using descriptive statistics. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Intra-individual changes of relevant serum chemistry values and eGFR before and after PTX were compared with the Sign test. Statistical analysis was performed with SPSS v. 24.0; p<0.05 was considered significant.

*Results: The median (interquartile range [IQR]) age was 54 (44-63) years; 42% were women and 83% had undergone deceased donor KT. The median daily dose of cinacalcet was 120 (60-120) mg. Pre-PTX renal biopsy showed intratubular calcium phosphate crystals in 2 patients. The median interval between KT and PTX was 169 (134 – 272) days, and the median length of stay for the PTX was 3 (3-4) days. There were no cases of permanent injury of the recurrent laryngeal nerve or chronic hypocalcemia. Before PTX, median eGFR (ml/min/1.73m2), and serum intact parathyroid hormone (iPTH, pg/mL), calcium (Ca, mg/dL), phosphorus (Phos, mg/dL), and alkaline phosphatase (ALP, U/L) were 64 (44-83), 548 (363-1032), 10.8 (9.8-11.9), 2.4 (2.2-3), and 170 (126-297), respectively. The corresponding values at 3 months post-PTX were 50 (39-68), 46 (18-154), 9.4 (9-10.5), 3 (2.6-3.2), and 75 (61-120), respectively. One year post-PTX, eGFR, and serum Ca, Phos and ALP were 49 (40-70), 9.1 (8.5-9.6), 3.2 (2.9-3.5), and 77 (50-87), respectively. Comparing intra-individual pre-PTX to post-PTX values, ALP was lower at 3 and 12 months (p<0.01), iPTH was lower at 3 months (p=0.02) and Ca at 12 months (p<0.01); changes in eGFR or Phos were not statistically significant at 3 or 12 months.

*Conclusions: Our data suggest that early PTX is a safe and effective treatment for HPT after KT, with minimal complications. Early PTX was not associated with graft dysfunction in our study. Long term outcomes of early PTX need to be studied.

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