Abstract
Introduction
Secondary hyperparathyroidism (SHP) is common in end-stage renal disease and may progress
to persistent post-transplant hyperparathyroidism (PTHP) following renal transplantation
(RT). We sought to describe the frequency and determine factors associated with the
incidence of PTHP for patients undergoing RT at a single institution that restricts
RT for patients with uncontrolled SHP with a parathyroid hormone (PTH) of >800pg/mL
at time of initial transplant evaluation.
Methods
We conducted a single-institution retrospective study of adults undergoing index RT
from 2012 to 2020 who had a calcium and PTH level within 12 mo prior to RT and at
least 6 mo following RT. PTHP was defined as calcium of >10 mg/dL with an elevated
PTH > 88pg/mL at six or more months following RT. Univariate analysis and multivariable
logistic regression were performed for factors associated with developing PTHP.
Results
We identified 1110 patients with RT, 65 were excluded for prior RT, 549 did not have
a pre-RT and post-RT calcium, and PTH laboratories for inclusion, yielding 496 for
analysis. Following RT, 39 patients (7.9%) developed PTHP, compared to those who did
not develop PTHP; these patients had significantly higher pre-RT PTH, pre-RT calcium,
and frequency of calcimimetic therapy. In multivariable logistic regression factors
significantly associated with PTHP were pre-RT calcium of more than 10 mg/dL with
an odds ratio (OR) of 3.57 (95% confidence interval [CI] 1.52-8.39, P = 0.003) and pre-RT calcimimetic therapy with an OR 1.30 (95% CI 1.06-2.85, P = 0.041). Compared with patients who had a pre-RT PTH of less than 200 pg/mL, a PTH
of 200-399 pg/mL increased risk of PTHP with an OR of 4.52 (95% CI 1.95-21.5, P = 0.048) and a PTH of > 400 pg/mL increased risk of PTHP with an OR of 7.17 (95%
CI 1.47-34.9, P = 0.015). In this cohort, 11 patients (28.2%) with PTHP underwent parathyroidectomy
(PTx) at a mean of 1.4 y post-RT (standard deviation 0.87).
Conclusions
For patients required to have a PTH < 800pg/mL for initial transplant candidacy, the
subsequent incidence of PTHP is relatively low at 7.9%. Risk factors for PTHP include
higher pre-RT calcium and PTH levels and pre-RT calcimimetic therapy. PTx remains
underused in the treatment of PTHP. Further study is warranted to determine the optimal
PTH cutoff for transplant candidacy and recommendation for PTx in patients requiring
calcimimetic therapy for SHP.
Keywords
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Article info
Publication history
Published online: January 27, 2023
Accepted:
December 24,
2022
Received in revised form:
December 4,
2022
Received:
March 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
