Our Summary

This research paper discusses a condition called tertiary hyperparathyroidism, which can occur after a kidney transplant. This issue happens when the parathyroid glands in the neck produce too much parathyroid hormone, often due to kidney disease or dialysis. The condition can affect how well the transplanted kidney functions.

Treating this condition can involve medications (mainly a type called calcimimetics) or surgery to remove some or all of the parathyroid glands. However, in Japan, the national insurance system doesn’t cover the cost of calcimimetics.

The paper suggests that both types of surgery can help improve the issue of high calcium levels in the blood, which can be a symptom of this condition. It also suggests that any temporary worsening of the transplanted kidney’s function after surgery is not likely to have long-term negative effects.

However, the paper also highlights that having tertiary hyperparathyroidism after a kidney transplant can make both the transplanted kidney and the patient’s overall health worse. Surgery to remove the parathyroid glands can potentially improve these outcomes.

Despite these findings, the paper points out that there’s a lack of high-quality studies on this topic.

FAQs

  1. What is tertiary hyperparathyroidism and how is it related to kidney transplantation?
  2. What are the two types of parathyroidectomy and how do they impact hypercalcemia?
  3. Does parathyroidectomy affect the survival rate of kidney transplants and the overall patient survival rates?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to make sure to follow post-operative instructions carefully, including taking prescribed medications and attending follow-up appointments. It is important to monitor calcium levels and ensure proper healing to prevent complications and promote a successful recovery. Additionally, maintaining a healthy lifestyle with proper nutrition and exercise can also support overall healing and long-term health outcomes.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with tertiary hyperparathyroidism following kidney transplantation. These patients may have complications related to their dialysis period and may experience hypercalcemia. Treatments such as pharmacotherapy with calcimimetics or parathyroidectomy may be considered, with parathyroidectomy being a potential option for improving hypercalcemia. The decision to undergo parathyroidectomy may be influenced by the function of the transplanted allograft, with considerations for the type of surgery (subtotal or total with partial autograft) and the timing of surgery relative to the transplant. Overall, parathyroidectomy can be expected to improve prognosis for patients with tertiary hyperparathyroidism following kidney transplantation.

Timeline

Before parathyroidectomy:

  • Patient is diagnosed with tertiary hyperparathyroidism, typically as a complication of kidney transplantation.
  • Patient may experience symptoms such as bone pain, fatigue, weakness, and increased calcium levels in the blood.
  • Treatment options may include pharmacotherapy with calcimimetics, but may not be covered by insurance in some countries.
  • Surgical intervention with parathyroidectomy may be recommended if pharmacotherapy is ineffective.

After parathyroidectomy:

  • Patient undergoes either subtotal parathyroidectomy or total parathyroidectomy with partial autograft.
  • Surgical procedure aims to improve hypercalcemia and alleviate symptoms.
  • Concerns about postoperative allograft function may arise, especially in patients with compromised kidney function.
  • Transient deterioration of allograft function may occur, but is not expected to affect long-term graft survival.
  • Parathyroidectomy is expected to improve prognosis in both kidney transplant recipients and dialysis patients, potentially improving allograft and patient survival rates.

What to Ask Your Doctor

  1. What are the potential risks and complications of a parathyroidectomy procedure?

  2. How will a parathyroidectomy improve my symptoms and overall health?

  3. What type of parathyroidectomy procedure do you recommend for my specific condition?

  4. How long is the recovery period after a parathyroidectomy?

  5. Will I need to take any medications or make lifestyle changes after the surgery?

  6. How will the surgery affect the function of my transplanted kidney?

  7. What is the success rate of parathyroidectomy in improving hypercalcemia in kidney transplant recipients?

  8. Are there any alternative treatments to consider before opting for a parathyroidectomy?

  9. How often will I need to follow up with you after the surgery?

  10. Can you provide me with any additional resources or information about parathyroidectomy and its impact on kidney transplant recipients?

Reference

Authors: Nakamura M, Takiguchi S, Uehara S, Tomita Y. Journal: Ren Fail. 2024 Dec;46(1):2333919. doi: 10.1080/0886022X.2024.2333919. Epub 2024 Apr 4. PMID: 38575330