Journal of Shandong University (Health Sciences) ›› 2023, Vol. 61 ›› Issue (1): 58-61.doi: 10.6040/j.issn.1671-7554.0.2022.0819

• 临床医学 • Previous Articles    

Outcomes of kidney transplantation after surgical treatment in 4 patients with refractory secondary hyperparathyroidism

GUO Haonan1,2, HE Qingqing2, ZHOU Peng2, LI Xiaolei2, ZHUANG Xiaoxuan3, YUE Tao2, GAO Yuan2,4, XU Jing2, SHAO Changxiu1,2, LI Chenyu1,2, ZHUANG Dayong2   

  1. 1. Postgraduate Training Base of 960th Hospital of PLA Joint Logistics Support Force of Jinzhou Medical University, Jinan 250031, Shandong, China;
    2. Department of Thyroid and Breast Surgery, The 960th Hospital of PLA Joint Logistics Support Force, Jinan 250031, Shandong, China;
    3. International Medical College of Chongqing Medical University, Chongqing 400016, China;
    4. The 963th Hospital of PLA Joint Logistics Support Force, Jiamusi 154007, Heilongjiang, China
  • Published:2023-01-10

PDF (PC)

214

Abstract: Objective To analyze the timing of parathyroidectomy(PTx)in patients with refractory secondary hyperparathyroidism(rSHPT)willing to receive kidney transplantation and to explore the impact of surgery on kidney transplantation. Methods The clinical data of 4 patients who underwent PTx for rSHPT and then kidney transplantation(KTx)during Apr. 2010 and Dec. 2021 were retrospectively analyzed. The clinical parameters before and after the two surgeries were compared with Kruskal-Wallis test. Results All patients underwent total parathyroidectomy with auto-transplantation(tPTx+AT). After surgery, clinical symptoms such as skeletal pain and skin pruritus were completely relieved, and both parathyroid hormone(PTH)and serum phosphate returned normal. Before KTx, serum calcium returned to the normal level in one patient and slightly below normal in the other three patients. After KTx, during the follow-up of 52(6-100)months, the grafted kidney function was stable, estimated glomerular filtration rate(eGFR)increased from 5.35(4.50-5.80)(mL/min)preoperatively to 83.80(68.60-95.60)(mL/min)postoperatively(P=0.021), and no complications such as transplanted kidney insufficiency or graft dysfunction occurred. Conclusion For rSHPT patients willing to undergo kidney transplantation, total parathyroidectomy with auto-transplantation is suggested.

Key words: Uremia, Secondary hyperparathyroidism, Refractory, Kidney transplantation, Parathyroidectomy

CLC Number: 

  • R582
[1] 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 慢性肾脏病继发甲状旁腺功能亢进外科临床实践中国专家共识(2021版)[J]. 中国实用外科杂志, 2021, 41(8): 841-848.
[2] 韦星, 蔡明, 金海龙, 等. 肾移植术后继发性甲状旁腺功能亢进的临床分析[J]. 中华移植杂志(电子版), 2018, 12(2): 60-64. WEI Xing, CAI Ming, JIN Hailong, et al. Clinical analysis of secondary hyperparathyroidism after renal transplantation [J]. Chinese Journal of Transplantation(Electronic Edition), 2018, 12(2): 60-64.
[3] Nakai K, Fujii H, Ishimura T, et al. Incidence and risk factors of persistent hyperparathyroidism after kidney transplantation [J]. Transplantation Proc, 2017, 49(1): 53-56.
[4] La Manna G. Parathyroidectomy before or after transplantation: a dilemma still open! [J]. Artif Organs, 2018, 42(2): 127-130.
[5] Jeon HJ, Kim YJ, Kwon HY, et al. Impact of parathyroidectomy on allograft outcomes in kidney transplantation [J]. Transpl Int, 2012, 25(12): 1248-1256.
[6] Cohen E, Korah M, Callender G, et al. Metabolic disorders with kidney transplant [J]. Clin J Am Soc Nephrol, 2020, 15(5): 732-742.
[7] Triponez F, Clark OH, Vanrenthergem Y, et al. Surgical treatment of persistent hyperparathyroidism after renal transplantation [J]. Ann Surg, 2008, 248(1): 18-30.
[8] Patecki M, Scheffner I, Haller H, et al. Long-term renal graft outcome after parathyroidectomy-a retrospective single center study [J]. BMC Nephrol, 2020, 21(1): 53.
[9] van der Plas WY, Moumni M, von Forstner PJ, et al. Timing of parathyroidectomy does not influence renal function after kidney transplantation [J]. World J Surg, 2019, 43(8): 1972-1980.
[10] Chen J, Jia X, Kong X, et al. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: a systematic review and meta-analysis [J]. Nephrology(Carlton), 2017, 22(5): 388-396.
[11] Esbrit P, Santos S, Ortega A, et al. Parathyroid hormone-related protein as a renal regulating factor. From vessels to glomeruli and tubular epithelium [J]. Am J Nephrol, 2001, 21(3): 179-184.
[12] Bergenfelz A, Nordenström E, Almquist M. Morbidity in patients with permanent hypoparathyroidism after total thyroidectomy [J]. Surgery, 2020, 167(1): 124-128.
[13] 王海峰, 张凌, 姚力, 等. 三种不同甲状旁腺切除术治疗继发性甲状旁腺功能亢进425例疗效比较[J]. 中国血液净化, 2016, 15(9): 455-458. WANG Haifeng, ZHANG Ling, YAO Li, et al. Efficacy comparison of the three parathyroidectomy methods in 425 patients with secondary hyperparathyroidism [J]. Chinese Journal of Blood Purification, 2016, 15(9): 455-458.
[14] Littbarski SA, Kaltenborn A, Gwiasda J, et al. Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: effect of pretransplant versus early or late post-transplant parathyroidectomy [J]. Surgery, 2018, 163(2): 373-380.
[15] Çeltik A, ?瘙塁en S, Yılmaz M, et al. The effect of hypercalcemia on allograft calcification after kidney transplantation [J]. Int Urol Nephrol, 2016, 48(11): 1919-1925.
[16] 张凌, 熊敏. 肾移植与三发性甲状旁腺功能亢进[J]. 内科理论与实践, 2018, 13(4): 197-201. ZHANG Ling, XIONG Min. Renal transplantation and tertiary hyperparathyroidism [J]. Journal of Internal Medicine Concepts & Practice, 2018, 13(4): 197-201.
[17] Callender GG, Malinowski J, Javid M, et al. Parathyroidectomy prior to kidney transplant decreases graft failure [J]. Surgery, 2017, 161(1): 44-50.
[18] Coyne DW, Delos Santos R. Evaluating the safety and rationale for cinacalcet posttransplant hyperparathyroidism and hypercalcemia [J]. Am J Transplant, 2014, 14(11): 2446-2447.
[1] ZHANG Hongbin, ZHAO Hanhui, WANG Suxia, ZHOU Peng, HE Qingqing, WANG Yanqun, DING Weiping, LIU Gang. Perioperative observation and postoperative risk factors of severe hypocalcemia after parathyroidectomy: a report of 303 cases [J]. Journal of Shandong University (Health Sciences), 2020, 1(9): 14-20.
[2] MAO Yijie, ZHANG Xufeng, LIU Shuangde, LIU Xiaoli, YAN Jieke, XU Dongsheng, PAN Wengu, TIAN Chuan. Efficacy and safety of direct-acting antiviral therapy for hepatitis C after renal transplantation [J]. Journal of Shandong University (Health Sciences), 2019, 57(1): 75-80.
[3] FENG Jingjing, ZHANG Luwei, ZHAO Peng, GUO Ning, TIAN Jun, CUI Xianquan. Application of CDFI in the establishment and evaluation of autogenous arteriovenousfistula [J]. Journal of Shandong University (Health Sciences), 2018, 56(7): 65-69.
[4] SHENG Xuan, WANG Yonge, GUO Dan, LAN Meng, FAN Fengjing, DING Hongyu. Effects of body mass index and renal subcutaneous depth on the results of virtual touch tissue imaging quantification in renal transplant patients [J]. Journal of Shandong University (Health Sciences), 2018, 56(12): 68-72.
[5] LIU Caifeng, WANG Mingming, LI Xinli, CUI Sunan. Efficacy of tolvaptan in the treatment of cirrhosis complicated with refractory ascites and hyponatremia [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(1): 33-37.
[6] LIU Yan, LIU Cong-cong, SHI Dan-dan, SUN Xiao, LI Jie. Value of virtual touch tissue quantification in the diagnosis of chronic allograft nephropathy after renal transplantation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2013, 51(8): 78-81.
[7] HAN Xue, WANG Qing, CUI Fengyu. Application of multislice CT angiography  in living renal donors before nephrectomy [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2010, 48(4): 102-105.
[8] WANG Jue,LIU Jun-li,ZHAO Jing-jie. Relationship between chronic glomerulonephritis and the human leukocyte antigen DRB1 [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2008, 46(8): 759-762.
[9] ZHAO Jing-jie,LIU Jun-li,TIAN Chuan,ZHANG Cai. Effect of vitamin B on hyperhomocysteinemia in renal-transplant recipients [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(8): 771-773.
[10] CONG Min,JIANG Bei,HU Zhao,LI Wei,MIAO Hua,FU Yu-qin,LI Yan-guo. Leflunomide in the treatment of refractory primary nephrotic syndrome [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2007, 45(3): 295-298.
[11] WANG Hong-wei,LIU Shuang-de,YAN Jie-ke,TIAN Chuan,XU Dong-sheng. Renal retransplantation in 41 cases [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(7): 722-725.
[12] WEN Rong-zhu,Paul Keown,Vivian Wu,LIU Gang,L XUE-ai,SONG Chun-yan,GUAN Guang-ju. Predictive value of flow cytometry crossmatch to oneyear graft loss following kidney transplantation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(6): 602-605.
[13] SUN Lu-yan,ZHANG He. [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(11): 1124-1127.
[14] WANG Hong-wei,LIU Shuang-de,TIAN Chuan,YAN Jie-ke,XU Dong-sheng,ZHENG Wan-hong. Vesania after kindney transplantation [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2006, 44(10): 1072-1075.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright 2018 © Editorial office of Journal of Shandong University (Health Sciences)
Supported by Beijing Magtech Co.Ltd