Effect of Parathyroidectomy Timing on the Successful Resolution of Tertiary Hyperparathyroidism in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.

Introduction: Tertiary hyperparathyroidism following kidney transplantation is a well-recognized complication in patients with pre-existing mineral imbalances due to chronic renal failure. Parathyroidectomy remains the only definitively curative option for tertiary hyperparathyroidism. The optimal timing of parathyroidectomy, before or after transplantation, is debated in the literature. This study aims to assess whether parathyroidectomy timing affects the successful resolution of tertiary hyperparathyroidism in patients with a functional kidney transplant. Methods: We conducted a systematic review and meta-analysis of the available literature collating the effect of pre- versus post-transplantation parathyroidectomy on the resolution of tertiary hyperparathyroidism. We compared the follow-up parathyroid hormone and calcium levels of patients subjected to either of these two approaches. Results: Three studies were identified, encompassing a total of 223 patients. The meta-analysis of available data yielded no statistically significant difference between pre- and post-kidney transplantation parathyroidectomy in terms of serum parathyroid hormone (SMD -0.19, 95% CI -0.92 to 0.55, p = 0.62) and calcium levels (SMD -0.75, 95% CI -2.30 to 0.80, p = 0.35). Conclusions: We demonstrated no significant difference between pre- and post-transplantation parathyroidectomy when it comes to the treatment of tertiary hyperparathyroidism. This meta-analysis is limited by the small number of studies included, reducing its statistical power. Therefore, additional studies are required to identify the optimal timing of intervention for the effective management of tertiary hyperparathyroidism in kidney transplant recipients.