US-guided percutaneous radiofrequency ablation of secondary hyperparathyroidism as a bridge to renal transplantation

Abstract

Purpose

Secondary hyperparathyroidism (SHPT) is a frequently encountered problem in patients with end-stage renal disease (ESRD) prior to renal transplantation (RTP), and the successful management of SPHP currently is challenging. In this study, we aimed to investigate the effectiveness of radiofrequency ablation (RFA) for SHPT as a bridge to RTP and to evaluate post-transplantation outcomes.

Methods

Patients with SHPT receiving RFA treatment were retrospectively reviewed, and those underwent RTP after ablation were enrolled. Serum parathyroid hormone (PTH), calcium, and phosphate levels were collected before ablation and at follow-up periods. The primary endpoints are PTH values at time of transplantation and at the final follow-up. The secondary endpoints were RFA-related complications, serum calcium and phosphate concentrations, and allograft function.

Results

Eleven patients with 43 enlarged parathyroid glands were treated with 16 RFA sessions and enrolled in the study. Complete ablation was achieved in all glands with transient hoarseness and hypocalcemia occurring in two and five of the treatments, respectively. At time of transplantation, serum PTH levels (246.7 ± 182.6 pg/mL) were significantly lower than that before RFA (1666.55 ± 874.48 pg/mL, p < 0.001) and were all within guideline-oriented range. The median follow-up period was 57.2 months. At last visit, all patients were alive, with normal PTH values and functioning grafts.

Conclusions

Ultrasound-guided RFA is effective for destroying hyperplastic parathyroid tissues in SHPT patients, whose PTH values fall within the guideline-oriented range both pre-and post-transplantation. Percutaneous RFA acts as an effective bridge to RTP and might provide a new management paradigm designed to improve post-transplant outcomes.

Keywords:

• Hyperparathyroidism
• radiofrequency ablation
• thermal ablation
• renal transplantation
• parathyroid hormone

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data can be availability from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported in part by the National Natural Science Foundation of China [Grants 82171943, 82272005], Shanghai Rising-Star Program [21QA1407200], and Special Project for Clinical Research of Health Industry of Shanghai Health Commission [20214Y0151].