Parathyroidectomy versus cinacalcet for tertiary hyperparathyroidism; a retrospective analysis
2019
Introduction Tertiary hyperparathyroidism (tHPT), i.e., persistent HPT after kidney transplantation, affects 17–50% of transplant
recipients. Treatment of tHPT is mandatory since persistently elevated PTH concentrations after KTx increase the risk of renal
allograft dysfunction and osteoporosis. The introduction of cinacalcet in 2004 seemed to offer a medical treatment alternative to
parathyroidectomy (PTx). However, the optimal management of tHPT remains unclear.
Methods A retrospective analysis was performed on patients receiving a kidney transplantation (KT) in two academic centers in
the Netherlands. Thirty patients undergoing PTx within 3 years of transplantation and 64 patients treated with cinacalcet 1 year
after transplantation for tHPT were included. Primary outcomes were serum calcium and PTH concentrations 1 year after KT and
after PTx.
Results Serum calcium normalized in both the cinacalcet and the PTx patients. PTH concentrations remained above the upper
limit of normal (median 22.0 pmol/L) 1 year after KT, but returned to within the normal range in the PTx group (median
3.7 pmol/L). Side effects of cinacalcet were difficult to assess; minor complications occurred in three patients. Re-exploration
due to persistent tHPT was performed in three (10%) patients.
Conclusion In patients with tHPT, cinacalcet normalizes serum calcium, but does not lead to a normalization of serum PTH
concentrations. In contrast, PTx leads to a normalization of both serum calcium and PTH concentrations. These findings suggest
that PTx is the treatment of choice for tHPT.
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