Impact of Pre-Transplant Parathyroidectomy on Graft Survival: A Comparative Study of Renal Transplant Patients (2005-2015)

Background: Hyperparathyroidism poses significant risks for patients prior to kidney transplantation. However, the outcomes of patients who undergo parathyroidectomy before renal transplantation compared to those without such a procedure remain uncertain. This real-world data study aimed to examine the clinical outcomes of both pa-tient groups. Material/Methods: Using the Taiwan National Health Insurance Research Database, we conducted a retrospective cohort study on patients who underwent renal transplantation between January 2005 and December 2015. The patients were divided into two groups: a case group (n=294) with parathyroidectomy and a control group (n=588) without the need for parathyroidectomy before kidney transplantation. The groups were matched based on age, sex, dialysis vintage, and baseline characteristics at a 1: 2 ratio. Hazard ratios (HR) were estimated using the Cox regression model. The main outcomes assessed were graft failure, mortality, and major adverse cardiovascu-lar events (MACE) recorded until December 2019. Results: During a mean follow-up period of 6 years, a significant difference was observed in graft failure (HR 1.40; 95% confidence interval 1.10-1.79, p=0.007) between the two groups. After further adjustment, graft failure re-mained significant (HR 1.52; 95% CI 1.07-2.15, p=0.019). Additionally, machine learning-based feature selec-tion identified the importance of parathyroidectomy (ranked 9 out of 11) before kidney transplantation in pre-dicting subsequent graft failure. Conclusions: Our study demonstrates that severe hyperparathyroidism requiring parathyroidectomy before kidney trans-plantation may contribute to poor post-transplant graft outcomes compared to patients who do not require parathyroidectomy.

Automated summary

This study compared the clinical outcomes of patients who underwent parathyroidectomy before renal transplantation with those who did not. The results showed that severe hyperparathyroidism requiring parathyroidectomy before kidney transplantation may contribute to poor post-transplant graft outcomes.