Parathyroidectomy versus cinacalcet in the treatment of tertiary hyperparathyroidism after kidney transplantation: a retrospective study

Background: Hyperparathyroidism is common in patients with chronic kidney disease with reduced renal function and has been ob-served after kidney transplantation. The optimal treatment for cases in which hyperparathyroidism persists after kidney transplanta-tion has not been determined. Methods: This retrospective study included 83 patients with tertiary hyperparathyroidism who underwent kidney transplantation be-tween 2000 and 2018 at a single tertiary center in Korea. Sixty-four patients underwent parathyroidectomy and 19 patients were treated with cinacalcet following renal transplantation. Biochemical parameters and clinical outcomes were compared between the two groups. Results: Serum calcium and parathyroid hormone (PTH) levels improved in both the parathyroidectomy and cinacalcet groups. One year after treatment, parathyroidectomy resulted in a lower mean serum calcium level than cinacalcet (9.7 ?? 0.7 mg/dL vs. 10.5 ?? 0.7 mg/dL, p = 0.001). Regarding serum PTH, the parathyroidectomy group showed a significantly lower PTH level than the cinacalcet group at 6 months (129.1 ?? 80.3 pg/mL vs. 219.2 ?? 92.5 pg/mL, p = 0.002) and 1 year (118.8 ?? 75.5 pg/mL vs. 250.6 ?? 94.5 pg/ mL, p < 0.001). There was no statistically significant difference in the incidence of kidney transplant rejection, graft failure, cardiovas-cular events, fracture risk, or bone mineral density changes between the two groups. Conclusion: Parathyroidectomy appears to reduce PTH and calcium levels effectively in tertiary hyperparathyroidism. However, creati-nine level and allograft rejection should be monitored closely.

Automated summary

In patients with tertiary hyperparathyroidism after kidney transplantation, both parathyroidectomy and cinacalcet treatment effectively improve serum calcium and PTH levels, with parathyroidectomy group showing better long-term outcomes.