Clinicopathological Analysis of Persistent Hypercalcemia and Hyperparathyroidism After Kidney Transplantation in Long-Term Dialysis Patients
Clinicopathological Analysis of Persistent Hypercalcemia and Hyperparathyroidism After Kidney Transplantation in Long-Term Dialysis Patients
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DOI：
10.1111/1744-9987.12018
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发表时间：
2013-10-01
影响因子：
1.9
通讯作者：
Tomikawa, Shinji
中科院分区：
文献类型：
--
作者：
Nakamura, Michio;Tanaka, Kiho;Tomikawa, Shinji
由于严重缺乏供者，日本长期透析患者的已故供者肾移植一直在增加。长期透析患者甲状旁腺常出现由弥漫性到结节性增生的质变。只有少数研究报道了长期(10年)透析患者肾移植后持续性甲状旁腺功能亢进症的临床病理分析。本研究从2002年至2010年连续进行了已故供者肾移植，测量了与骨骼和矿物质紊乱相关的生化参数，并检查了甲状旁腺切除病例的甲状旁腺组织。入选受试者34例(男性22例，平均年龄53.8±7.9岁；平均透析时间14.4±4.3年)。对移植后12个月高血钙组的潜在预测因素的多因素分析显示，移植前和移植后早期的钙和甲状旁腺激素水平是显着的决定因素。病理检查显示，许多腺体呈结节状增生，即使在重量为4岁的小腺体中也是如此，即使在重量较轻的甲状旁腺中也可见结节状增生。移植前高钙和甲状旁腺激素水平是长期高血钙症的预测因素。持续性甲状旁腺机能亢进症被认为是由残留的结节状增生引起的，即使腺体很小。虽然最好的治疗选择是在移植前的等待期进行甲状旁腺切除术，但我们建议在移植后6个月持续高血钙的情况下进行甲状旁腺切除术。
Deceased donor kidney transplantation in long-term dialysis patients in Japan has been increasing because of a severe lack of donors. Parathyroid glands of long-term dialysis patients often show qualitative morphological changes from diffuse to nodular hyperplasia. Only a few studies have reported the clinicopathological analysis of persistent hyperparathyroidism after kidney transplantation in long-term (>10 years) dialysis patients. This study on consecutive deceased donor kidney transplantation performed from 2002 to 2010 measured biochemical parameters related to bone and mineral disorders and examined parathyroid tissues in parathyroidectomy cases. Thirty-four subjects (22 males; mean age, 53.8 +/- 7.9 years; mean dialysis period, 14.4 +/- 4.3 years) were enrolled. Multivariate analysis of potential predictors for the hypercalcemia group at 12 months after transplantation showed that pre-transplantation and early post-transplantation calcium and parathyroid hormone levels were significant determinants. Pathological examination showed that a number of glands showed nodular hyperplasia, even in small glands weighing4 years), with nodular hyperplasia being found even in low-weight parathyroid glands. Pre-transplant high calcium and parathyroid hormone levels were the predictors for the prolonged hypercalcemia. Persistent hyperparathyroidism was considered to be caused by remaining nodular hyperplasia, even if the glands were small. Although the best treatment option is to perform a parathyroidectomy in the waiting period before transplantation, we suggest that it be performed in cases with prolonged hypercalcemia of >6 months after transplantation.