PDF(Pubmed)
Abstract：
Hyperparathyroidism (HPT) with hypercalcemia, often deemed irreversible and detrimental to graft survival post-kidney transplantation (KT), prompts pre-transplant parathyroidectomy in hypercalcemic patients. In this retrospective analysis of 1212 kidney transplant recipients (KTRs) between 2006 and 2019, the incidence and effect of persistent HPT and hypercalcemia on graft and patient survival, and risk factors for persistence were analyzed until 60 months of follow up (FU). At KT, 5.7% (n = 69) had no HPT, 32.7% (n = 396) had HPT without hypercalcemia and 37.0% (n = 448) had HPT with hypercalcemia. At 2 years FU, 26.4% (n = 320) of patients had no HPT and 6% (n = 73) had HPT with hypercalcemia. Dialysis and dialysis duration were linked to HPT development, while dialysis, KT waiting time and donor type correlated with persisting hypercalcemia after KT. KTRs with normalized PTH and recovered hypercalcemia had improved death-censored graft survival (p < 0.001) and overall patient survival (p < 0.001). HPT with hypercalcemia is frequent at time of KT with normalization of PTH and calcium in a substantial proportion of patients after a KT. These findings question the routine pre-KT parathyroidectomy for suspected parathyroid autonomy. Persisting HPT, especially with hypercalcemia, adversely affects graft and patient survival, suggesting the need for more aggressive treatment of HPT, especially in cases of persisting hypercalcemia.
摘要：
甲状旁腺功能亢进（HPT）伴高钙血症，通常被认为是不可逆的，对肾移植（KT）后的移植物存活有害，提示高钙血症患者移植前甲状旁腺切除术。在2006年至2019年间对1212例肾移植受者（KTRs）的回顾性分析中，持续性HPT和高钙血症对移植物和患者生存的发生率和影响，和持续的危险因素分析，直到60个月的随访（FU）。在KT,5.7%(n=69)没有HPT，32.7％（n=396）的HPT无高钙血症，37.0％（n=448）的HPT伴高钙血症。在两年FU，26.4％（n=320）的患者没有HPT，6％（n=73）的患者患有高钙血症。透析和透析持续时间与HPT发展有关，而透析,KT等待时间和供体类型与KT后持续的高钙血症相关。PTH正常化和高钙血症恢复的KTRs改善了死亡审查的移植物存活率(p<0.001)和患者总存活率(p<0.001)。高钙血症的HPT在KT时很常见，在KT后很大一部分患者中PTH和钙正常化。这些发现对怀疑甲状旁腺自主性的常规KT甲状旁腺切除术提出了质疑。持续的HPT,尤其是高钙血症，对移植物和患者的生存产生不利影响，表明需要更积极的治疗HPT，尤其是在持续高钙血症的情况下。
