Second Chances or Setbacks: The Impact of Parathyroidectomy on Graft Failure Post-Kidney Transplantation

Tertiary hyperparathyroidism is a common complication in kidney transplant (KT) recipients, often persisting despite successful graft function. However, the optimal treatment for improving long-term graft survival remains unclear. Parathyroidectomy (PTX) offers a definitive approach to restoring calcium homeostasis. This study aims to assess the effect of PTX on graft failure, the need for dialysis, and renal osteodystrophy in the 2 groups.

A retrospective analysis of electronic medical records from a multi-institutional database (TriNetX) was completed. Patients diagnosed with tertiary hyperparathyroidism after KT were divided into 2 groups based on the type of intervention: cinacalcet or PTX. Patients were followed for up to 5 years, starting from the day after initiating cinacalcet or PTX. Propensity score matching was used to balance demographics, comorbidities, creatinine levels before intervention, and vitamin D deficiency. Cox regression analysis was performed to determine measures of association.

A total of 811 patients were included in each treatment group after propensity score matching. During the study period, 42.8% of patients (n = 347 of 811) receiving cinacalcet became dialysis-dependent, compared with 30.9% (n = 251 of 811) of those who underwent surgery (p < 0.01). Regarding renal osteodystrophy, 10.8% of patients (n = 74 of 684) on cinacalcet developed the condition, whereas only 5.1% (n = 32 of 628) in the PTX group experienced it (p < 0.01). Additionally, 17.2% of those on cinacalcet experienced graft failure, compared with 12.6% in the PTX group (p < 0.04).

Patients who underwent PTX experienced lower rates of KT failure and dialysis, outperforming those treated with cinacalcet; however, this finding should be cautiously interpreted regarding its clinical relevance. Improved electrolyte balance and parathyroid hormone levels may be associated with a lower rate of renal osteodystrophy.