CLINICS 2011;66(3):431-435 Table 1 - Demographic and clinical data. Age (years) Sex Male (%) IMMUNOSUPPRESSION Steroids Cyclosporin A Tacrolimus Azathioprin Mycophenolate mofetil or Sodium Rapamycin Duration of dialysis before transplantation (months) Time after transplantation (months) Creatinine before surgery (mg/dL) Creatinine clearance (Cokcroft-Gault) (mL/minute) Legend: PTX = parathyroidectomy; NON-PTX = other operations. found in 11% of the cases and in 21% of the controls. Diabetes was not observed in any of the study cases but was present in 5% of the controls. The etiology of renal failure was unknown or missing in 11% of the patients who underwent parathyroidectomy. The donated kidney was from a deceased donor in 84% of the cases in both groups. Immunosuppression was similar in both groups. Table 1 shows the mean age, gender, type of immunosuppressant, duration of dialysis before transplantation, time of surgery after transplantation, mean preoperative creatinine and preoperative estimated glomerular filtration rate for patients in the two groups. In the parathyroidectomy group, the mean PTH was 350 pg/mL (range 134-3950) and the mean total calcium was 10.7 mg/dL (range 10.2-12.7). There were no operative deaths. A significant increase in serum creatinine from 1.58 to 2.29 mg/dL (p,0.05) was noted in the parathyroidectomy group within the first 5 days after parathyroidectomy. An insignificant increase in serum creatinine occurred in the control group in the first 5 days after surgery (baseline: 1.49mg/dL; day 5: 1.65mg/dL). On the fifth day after surgery, creatinine was higher in the parathyroidectomy group (p,0.05) than in the control group. Figure 2 - Renal Function before surgery, after surgery and at the last follow up. 433 PTX Group (n = 19) NON-PTX Group (n = 19) 44.7¡10.7 36% 100% 58% 41% 21% 79% 0% 86.1 (0-204) 36 (7-69) 1.58 ¡ 0.6 48.6 48.5¡12.3 67% 100% 74% 21% 32% 68% 5% 57.2 (0-120) 28 (3-76) 1.49 ¡ 0.6 44.6 P 0.20 0.10 1.0 0.49 0.29 0.71 0.71 1.0 0.047 0.23 0.65 0.9 Parathyroidectomy after kidney transplantation Ferreira GF et al. In the parathyroidectomy group, renal function stabilized after 24 ¡ 10 months of follow up. At that time, the mean serum creatinine value (1.91 mg/dL) was not statistically different from baseline. Renal function stabilized after 31 ¡ 24 months in the non-parathyroidectomy group, with a final follow-up creatinine mean value of 1.72 mg/dL (Figure 2). At the long-term follow up, one death related to sepsis had occurred in the parathyroidectomy group, and two deaths related to cardiovascular disease had occurred in the non-parathyroidectomy group. None of the deaths were related to the surgical procedures. Censoring for death revealed similar findings. In the group of patients who underwent parathyroidectomy after the kidney transplanta- tion, only two patients lost the graft, with one at 22 months post-surgery and the other at 63 months. The three patients were diagnosed with chronic allograft nephropathy. None of the controls lost their kidney grafts. The difference in graft loss was not statistically significant (p = 0.48). DISCUSSION The decision to recommend parathyroid surgery after kidney transplantation is a difficult one. Evidence-based