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Parathyroidectomy prior to kidney transplant decreases graft failure
- Source :
- Surgery. 161:44-50
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Uncorrected uremic hyperparathyroidism is associated with delayed graft function after kidney transplantation. The current guidelines of the Kidney Disease Improving Global Outcomes recommend maintaining parathyroid hormone ≤9x normal in patients pre-kidney transplantation. This study explores the effect of increased levels of serum parathyroid hormone and preoperative parathyroidectomy on outcomes after kidney transplantation.A retrospective review was performed of adult patients who underwent kidney transplantation between January 1, 2005, and December 31, 2014, at a single institution. Biochemistries and outcomes were analyzed pre-kidney transplantation and at 30 days, 6 months, and 1 year post-kidney transplantation.A total of 913 patients underwent kidney transplantation from 2005-2014. Graft survival 1 year post-kidney transplantation was 97.8%. Overall, 462 (50.6%) patients had a pre-kidney transplantation diagnosis of uncorrected uremic hyperparathyroidism, which was associated with complications in the first year post-kidney transplantation (odds ratio 1.44; 95% confidence interval, 1.11-1.87); no statistical association with delayed graft function or graft failure was detected. Pre-kidney transplantation parathyroid hormone ≥6x normal was associated with post-kidney transplantation graft failure (P .05). A total of 57 (6.2%) patients underwent pre-kidney transplantation parathyroidectomy, which was associated with lesser risk of graft failure (odds ratio: 0.547; 95% confidence interval, 0.327-0.913), but no statistically significant association with delayed graft function or complications were detected.Pre-kidney transplantation parathyroidectomy decreases post-kidney transplantation graft failure and may benefit patients whose serum parathyroid hormone levels decrease into the target range of current Kidney Disease Improving Global Outcomes guidelines.
- Subjects :
- Adult
Graft Rejection
Male
Parathyroidectomy
medicine.medical_specialty
Databases, Factual
medicine.medical_treatment
030232 urology & nephrology
Parathyroid hormone
Risk Assessment
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Preoperative Care
Confidence Intervals
Odds Ratio
Humans
Medicine
Kidney transplantation
Aged
Retrospective Studies
Aged, 80 and over
Hyperparathyroidism
urogenital system
business.industry
Graft Survival
Odds ratio
Middle Aged
medicine.disease
Kidney Transplantation
Confidence interval
Surgery
Transplantation
Treatment Outcome
surgical procedures, operative
Parathyroid Hormone
030220 oncology & carcinogenesis
Kidney Failure, Chronic
Female
business
Kidney disease
Subjects
Details
- ISSN :
- 00396060 and 20052014
- Volume :
- 161
- Database :
- OpenAIRE
- Journal :
- Surgery
- Accession number :
- edsair.doi.dedup.....5fe657417cea4d6fadfca69493009376