Kidney Week

Abstract: FR-PO252

Comparison of Parathyroidectomy vs. Cinacalcet in Treatment of Hyperparathyroidism after Kidney Transplant: A Meta-Analysis

Session Information

• Mineral Bone Disease: Transplant and Kidney Stones
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Palma, Raphael Hemann, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio grande do sul, Brazil

Raphael Hemann Palma, MD

• Rech, Eduardo Lange, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil

Eduardo Lange Rech, MD

• Andrade, Juliana Alves Manhaes, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio grande do sul, Brazil

Juliana Alves Manhaes Andrade

• Meinerz, Gisele, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio grande do sul, Brazil

Gisele Meinerz, MD, PhD

• Keitel, Elizete, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Rio grande do sul, Brazil

Elizete Keitel, MD, PhD

Background

Hyperparathyroidism after kidney transplant (PT-HPT) is a common condition and up to 50% of patients have persistent elevated parathyroid hormone (PTH) levels after 1 year after transplant. The persistent PT-HPT has been associated with higher risk of bone fractures, increased mortality, and decreased allograft survival; therefore, the management of this pathology has varied between transplant centers. Due to the controversies of evidence, we performed a meta-analysis comparing cinacalcet with surgical treatment in PT-HPT.

Methods

We systematically searched PubMed, Scopus, and Cochrane Central Register using terms: ("Kidney Transplantation"[Mesh]OR"Kidney transplantation" OR "Kidney transplant") AND ("Cinacalcet"[Mesh] OR Cinacalcet OR Calcimimetic OR Calcimimetics) AND ("Parathyroidectomy"[Mesh] OR Parathyroidectomy OR surgery). This review was registered in PROSPERO. RevMan Web was used for statistical analysis. Pooled treatment effects for binary endpoints were compared using risk ratio (RR) with 95% confidence interval (CI) and continuous outcome were compared through mean difference. Heterogeneity was examined with Cochran Q test and I 2 statistics. A random effect model was used for outcomes. Risk of bias and quality assessment of individual studies were analyzed with the Cochrane Collaboration’s tool.

Results

From 682 screened studies eleven were included, nine retrospective studies and 2 randomized trials. Mean follow-up ranged from 90 days to 2.500 days. Normal calcium serum levels were more frequent in the surgery group (94.1%) than cinacalcet group (71%) and the difference was statistically significant between groups (OR 1.33; 95% CI 1.20-1.48; p < 0.00001, I²=0%). The incidence of normalized PTH levels was significantly higher in the surgery group (52.5% vs 22.3%, OR 3.18; 95% CI 1.15 - 8.81, p = 0.03, I² = 90%). Graft failure was significant lower in parathyroidectomy group (2.1% vs 2.6%, OR 0.45; 95% CI 0.26-0.77, p= 0.004, I²= 0%). There was no significant difference in mortality between surgery (1%) and cinacalcet group (0.9%), OR 0.61, 95% CI 0.26 - 1.43, p= 0.26, I²= 0%).

Conclusion

Parathyroidectomy is more effective in controlling calcium and PTH levels in patients with PT-HPT and reduces risk of graft failure but without impact in mortality.