To compare the outcomes of pre-transplant PTx and post-transplant PTx on graft loss, tertiary hyperparathyroidism (THPT), renal function, and complications, and to propose a clinical algorithm for PTx timing based on these outcomes.
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Key Findings:
Eight studies involving 4355 patients were included.
Graft loss events were low in both groups, with a trend toward lower graft loss in the pre-transplant PTx group; one study reported a significant adjusted odds ratio favoring pre-transplant PTx (0.547, 95% CI: 0.327–0.913).
Pre-transplant PTx was associated with lower 1-month eGFR but no long-term differences in eGFR or serum creatinine were observed.
Postoperative hypocalcemia rates were inconsistent across studies.
A large database study indicated higher 30-day composite morbidity for pre-transplant PTx without differences in mortality.
Interpretation:
Pre-transplant PTx may be associated with lower graft loss and comparable long-term renal function compared to post-transplant PTx. A personalized approach using a proposed algorithm may optimize clinical decision-making.
Limitations:
All included studies were observational, limiting the strength of the evidence.
Heterogeneity in outcome definitions and measurement methods prevented meta-analysis.
No relevant interventional studies have been published to date.
Conclusion:
A risk-stratified algorithm is proposed to guide PTx timing. Prospective studies are needed to validate this framework.
