HHS Public Access Author manuscript Author Manuscript
Surgery. Author manuscript; available in PMC 2017 January 01. Published in final edited form as: Surgery. 2016 January ; 159(1): 172–180. doi:10.1016/j.surg.2015.08.039.
Parathyroidectomy is Underutilized in Patients with Tertiary Hyperparathyroidism after Renal Transplantation Irene Lou, MD1, David F Schneider, MD, MS1, Glen Leverson, PhD1, David Foley, MD1, Rebecca Sippel, MD1, and Herbert Chen, MD1 1Department
of Surgery, University of Wisconsin, 600 Highland Ave., K3/705 CSC, Madison, Wisconsin, 53792
Author Manuscript
Abstract Background—Parathyroidectomy is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), parathyroidectomy can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of parathyroidectomy in patients with post-transplant 3HPT with the advent of cinacalcet. Method—We evaluated renal transplant patients between 1/1/2004-6/30/2012 with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) one 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 parathyroidectomy.
Author Manuscript
Results—We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent parathyroidectomy. Patients with higher levels of serum calcium (p 72 pg/mL, the upper limit of normal in our laboratory system. As PTH is not checked routinely prior to transplantation, we examined only post-transplant labs, because they are obtained at more frequent and regular intervals. In each of these patients, we collected all available corresponding serum levels of creatinine, albumin, calcium, PTH, and vitamin D at two time points: the first at 9-12 months after the date of transplantation, and the second at most recent follow up. Using the serum creatinine level, each patient then had an estimated glomerular filtration rate (GFR) calculated via the Cockcroft-Gault equation. According to the Kidney Disease Outcomes Quality Initiative,9 a severe decrease in renal function occurs when GFR < 30 mL/min/1.73m2. Exclusion of patients with GFR
Surgery. Author manuscript; available in PMC 2017 January 01. Published in final edited form as: Surgery. 2016 January ; 159(1): 172–180. doi:10.1016/j.surg.2015.08.039.
Parathyroidectomy is Underutilized in Patients with Tertiary Hyperparathyroidism after Renal Transplantation Irene Lou, MD1, David F Schneider, MD, MS1, Glen Leverson, PhD1, David Foley, MD1, Rebecca Sippel, MD1, and Herbert Chen, MD1 1Department
of Surgery, University of Wisconsin, 600 Highland Ave., K3/705 CSC, Madison, Wisconsin, 53792
Author Manuscript
Abstract Background—Parathyroidectomy is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), parathyroidectomy can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of parathyroidectomy in patients with post-transplant 3HPT with the advent of cinacalcet. Method—We evaluated renal transplant patients between 1/1/2004-6/30/2012 with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) one 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 parathyroidectomy.
Author Manuscript
Results—We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent parathyroidectomy. Patients with higher levels of serum calcium (p 72 pg/mL, the upper limit of normal in our laboratory system. As PTH is not checked routinely prior to transplantation, we examined only post-transplant labs, because they are obtained at more frequent and regular intervals. In each of these patients, we collected all available corresponding serum levels of creatinine, albumin, calcium, PTH, and vitamin D at two time points: the first at 9-12 months after the date of transplantation, and the second at most recent follow up. Using the serum creatinine level, each patient then had an estimated glomerular filtration rate (GFR) calculated via the Cockcroft-Gault equation. According to the Kidney Disease Outcomes Quality Initiative,9 a severe decrease in renal function occurs when GFR < 30 mL/min/1.73m2. Exclusion of patients with GFR
