Parathyroidectomy Versus Cinacalcet for Tertiary Hyperparathyroidism; a Retrospective Analysis

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2019 Feb 8

PMID 30729318

Citations 9

Authors

R R Dulfer

E Y Koh

W Y van der Plas

A F Engelsman

E J M Nieveen van Dijkum

R A Pol

L Vogt

M H de Borst

S Kruijff

A Schepers

N M Appelman-Dijkstra

J I Rotmans

D A Hesselink

C H J van Eijck

E J Hoorn

T M van Ginhoven

Affiliations

Soon will be listed here.

Abstract

Introduction: Tertiary hyperparathyroidism (tHPT), i.e., persistent HPT after kidney transplantation, affects 17-50% of transplant recipients. Treatment of tHPT is mandatory since persistently elevated PTH concentrations after KTx increase the risk of renal allograft dysfunction and osteoporosis. The introduction of cinacalcet in 2004 seemed to offer a medical treatment alternative to parathyroidectomy (PTx). However, the optimal management of tHPT remains unclear.

Methods: A retrospective analysis was performed on patients receiving a kidney transplantation (KT) in two academic centers in the Netherlands. Thirty patients undergoing PTx within 3 years of transplantation and 64 patients treated with cinacalcet 1 year after transplantation for tHPT were included. Primary outcomes were serum calcium and PTH concentrations 1 year after KT and after PTx.

Results: Serum calcium normalized in both the cinacalcet and the PTx patients. PTH concentrations remained above the upper limit of normal (median 22.0 pmol/L) 1 year after KT, but returned to within the normal range in the PTx group (median 3.7 pmol/L). Side effects of cinacalcet were difficult to assess; minor complications occurred in three patients. Re-exploration due to persistent tHPT was performed in three (10%) patients.

Conclusion: In patients with tHPT, cinacalcet normalizes serum calcium, but does not lead to a normalization of serum PTH concentrations. In contrast, PTx leads to a normalization of both serum calcium and PTH concentrations. These findings suggest that PTx is the treatment of choice for tHPT.

Citing Articles

Calcimimetics or parathyroidectomy for kidney transplant recipients: is there still a question? a systematic review, meta-analysis and trial sequential analysis.

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PMID: 39921811 DOI: 10.1007/s12020-025-04189-9.

Back to my future: life after surgery for tertiary hyperparathyroidism.

Morandi R, Guarneri C, Nardin M, Mitola S, Vettoretto N, Zanni G Langenbecks Arch Surg. 2024; 409(1):350.

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Outcome of surgical parathyroidectomy for tertiary hyperparathyroidism in kidney transplant recipients: tertiary hyperparathyroidism should not be ignored, for the sake of precious allografts.

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PMID: 38575330 PMC: 10997355. DOI: 10.1080/0886022X.2024.2333919.

Predictive factors for persistent hypercalcemia following parathyroidectomy in patients with persistent hyperparathyroidism after kidney transplantation: a retrospective cohort study.

Kim B, Kim H, Baek C, Kim Y, Pak S, Kwon D Int J Surg. 2023; 110(2):902-908.

PMID: 37983758 PMC: 10871572. DOI: 10.1097/JS9.0000000000000894.

Machine Learning-Derived Integer-Based Score and Prediction of Tertiary Hyperparathyroidism among Kidney Transplant Recipients: An Integer-Based Score to Predict Tertiary Hyperparathyroidism.

Hong N, Lee J, Kim H, Jeong J, Huh K, Rhee Y Clin J Am Soc Nephrol. 2022; 17(7):1026-1035.

PMID: 35688469 PMC: 9269627. DOI: 10.2215/CJN.15921221.

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