Hyperparathyroidism at 1 year after kidney transplantation is associated with graft loss

Crepeau, Philip; Chen, Xiaomeng; Udyavar, Rhea; Morris‐Wiseman, Lilah F.; Segev, Dorry L.; McAdams-DeMarco, Mara; Mathur, Aarti

doi:10.1016/j.surg.2022.07.031

Cited by 7 publications

(20 citation statements)

References 34 publications

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“…4,7,27 Similar to our findings in the transplant population, Crepeau et al noted higher graft loss in patients with post-KT HPT in their single-institution study. 7 However, they did not control for renal function, which directly affects PTH levels and is a significant confounder. Our results mirror that of Araujo et al, who in their study, found that persistent HPT at 1 year predicted graft loss, even when adjusted for eGFR.…”

Section: Discussionsupporting

confidence: 90%

“…The sub-analyses of hypercalcemic HPT and normocalcemic HPT remained statistically significant, which reflected that HPT with or without hypercalcemia post-KT adversely affects allograft function. The association between HPT, CKD progression, vascular events, and deaths have been described in the general CKD population 4,7,27 . Similar to our findings in the transplant population, Crepeau et al noted higher graft loss in patients with post-KT HPT in their single-institution study 7 .…”

Section: Discussionsupporting

confidence: 89%

“…The reported prevalence of persistent HPT post-KT varies widely from 20% to 80% 6–10 . This is mainly due to the discrepancy in the definition of persistent HPT and the reported time interval post-KT.…”

Section: Discussionmentioning

confidence: 99%

“…The effect that HPT has on allograft function is still currently unknown. Previous studies reported an association of persistent hyperparathyroidism with a worse allograft function 7–9 . However, whether this association is due to underlying allograft dysfunction or is a result of the impact of persistent HPT on allograft function remains unclear.…”

mentioning

confidence: 99%

“…Persistent HPT after successful KT is a major and often-underestimated problem 2 . The reported prevalence of persistent HPT post-KT in recent studies varies from 20% to 80% 6–10 . Risk factors for persistent HPT include the severity of HPT before KT; calcimimetics use pre-KT, duration of dialysis pre-KT, and donor kidney quality 3,6,8,11,12 …”

mentioning

confidence: 99%

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Resolution of Secondary Hyperparathyroidism after Kidney Transplantation and the Effect on Graft Survival

et al. 2023

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Objective: Hyperparathyroidism (HPT) is nearly universal in patients with end-stage kidney disease. Kidney transplantation (KT) reverses HPT in many patients, but most studies have only focused on following calcium and not parathyroid hormone (PTH) levels. We sought to study the prevalence of persistent HPT post-KT at our center and its effect on graft survival. Methods: Patients who underwent KT from January 2015 to August 2021 were included and characterized by post-KT HPT status at the most recent follow-up: resolved (achieving normal PTH post-KT) versus persistent HPT. Those with persistent HPT were further stratified by the occurrence of hypercalcemia (normocalcemic versus hypercalcemic HPT). Patient demographics, donor kidney quality, PTH and calcium levels, and allograft function were compared between groups. Multivariable logistic regression and Cox regression with propensity score matching were conducted. Results: Of 1554 patients, only 390 (25.1%) patients had resolution of renal HPT post-KT with a mean (±SD) follow-up length of 40±23 months. The median (IQR) length of HPT resolution was 5 (0–16) months. Of the remaining 1164 patients with persistent HPT post-KT, 806 (69.2%) patients had high PTH and normal calcium levels, while 358 (30.8%) patients had high calcium and high PTH levels. Patients with persistent HPT had higher parathyroid hormone (PTH) at the time of KT [403 (243–659) versus 277 (163–454) pg/mL, P<0.001] and were more likely to have received cinacalcet treatment before KT (34.9% vs. 12.3%, P<0.001). Only 6.3% of patients with persistent HPT received parathyroidectomy. Multivariable logistic regression showed race, cinacalcet use pre-KT, dialysis before KT, receiving an organ from a deceased donor, high PTH, and calcium levels at KT were associated with persistent HPT post-KT. After adjusting for patient demographics and donor kidney quality by propensity score matching, persistent HPT (HR 2.5, 95% CI 1.1–5.7, P=0.033) was associated with a higher risk of allograft failure. Sub-analysis showed that both hypercalcemic HPT (HR 2.6, 95% CI 1.1–6.5, P=0.045) and normocalcemic HPT (HR 2.5, 95% CI 1.3–5.5, P=0.021) were associated with increased risk of allograft failure when compared with patients with resolved HPT. Conclusion: Persistent HPT is common (75%) after KT and is associated with a higher risk of allograft failure. PTH levels should be closely monitored after kidney transplantation so that patients with persistent HPT can be treated appropriately.

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