Factors Associated With Persistent Post-transplant Hyperparathyroidism After Index Renal Transplantation

Walkenhorst, Zachary; Maskin, Alexander; Westphal, Scott G.; Fingeret, Abbey L.

doi:10.1016/j.jss.2022.12.030

Cited by 5 publications

(12 citation statements)

References 38 publications

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“…It was approved in the United States in 2004 for dialysis patients with secondary HPT 22 . As in our study, Sutton et al 6 and Walkenhorst et al 11 also found that pre-KT use of calcimimetics was independently associated with persistent HPT post-KT. This could be because patients prescribed with cinacalcet before KT had more severe secondary HPT or due to a rebound effect of HPT after discontinuing cinacalcet at the time of KT 23 …”

Section: Discussionsupporting

confidence: 81%

“…The American Association of Endocrine Surgeons (AAES) guidelines recommend PTx as the treatment of choice for patients with hypercalcemic HPT, and referral for PTx should be placed within 12 months post-KT 16 . However, the reported rate of PTx in KT recipients with HPT was low, ranging from 6.6% to 28.2% 6,11,33 . The PTx rate in our cohorts was 19.3% in the persistent HPT with hypercalcemia group and 0.5% in the normocalcemic HPT group, which further demonstrates that PTx is underused for HPT among KT recipients.…”

Section: Discussionsupporting

confidence: 49%

“…16 However, the reported rate of PTx in KT recipients with HPT was low, ranging from 6.6% to 28.2%. 6,11,33 The PTx rate in our cohorts was 19.3% in the persistent HPT with hypercalcemia group and 0.5% in the normocalcemic HPT group, which further demonstrates that PTx is underused for HPT among KT recipients.…”

Section: Discussionmentioning

confidence: 56%

“…They recommended using a PTH cutoff value of 150 pg/mL and 300 pg/mL to predict persistent HPT at 1-year post-KT, respectively. The results of age at KT and Black race as risk factors for persistent HPT were inconsistent 6,8,11 . This is likely due to the geographical differences in racial makeup, as 56.0% of KT recipients were Black in our study.…”

Section: Discussionmentioning

confidence: 59%

“…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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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 59%

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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Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism

Ramos,

Cortes,

Reis

et al. 2024

Braz. J. Nephrol.

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Introduction: Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world. Methods: We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS). Results: In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed. Conclusion: PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.

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Paratireoidectomia: ainda a melhor escolha para o tratamento do hiperparatireoidismo secundário grave

Ramos,

Cortes,

Reis

et al. 2024

Braz. J. Nephrol.

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Resumo Introdução: O manejo do hiperparat-ireoidismo secundário (HPTS) é uma tarefa desafiadora com diversos fatores que contribuem para o fracasso do tratamento. A terapia calcimimética revolucionou o manejo do HPTS, levando a alterações nas indicações e no momento apropriado da paratireoidectomia (PTX) em todo o mundo. Métodos: Comparamos taxas de resposta às abordagens clínica vs. cirúrgica do HPTS em pacientes em diálise de manutenção (DRC 5D) e pacientes transplantados renais (TxR). Foi realizada uma análise retrospectiva dos achados de um ano de acompanhamento. Pacientes com DRC 5D foram divididos em 3 grupos de acordo com a estratégia de tratamento: paratireoidectomia, manejo clínico sem cinacalcete (denominado padrão - P) e com cinacalcete (P + CIN). Os pacientes com TxR foram divididos em 3 grupos: PTX, CIN (uso de cinacalcete) e observação (OBS). Resultados: Na DRC 5D, encontramos uma redução significativa do paratormônio (PTH) em todos os grupos. Apesar de todos os grupos apresentarem um PTH mais elevado no início do estudo, identificamos uma redução mais acentuada no grupo PTX. Com relação ao HPTS grave, a diferença entre os grupos foi evidentemente maior: 31%, 14% e 80% dos grupos P, P + CIN e PTX atingiram níveis adequados de PTH, respectivamente (p< 0,0001). Com relação à população TxR, embora a diferença não tenha sido tão impressionante, também foi observada uma taxa maior de sucesso no grupo PTX. Conclusão: A PTX ainda parece ser a melhor escolha de tratamento para o HPTS, especialmente em pacientes com doenças prolongadas em cenários sem recursos.

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Factors Associated With Persistent Post-transplant Hyperparathyroidism After Index Renal Transplantation

Cited by 5 publications

References 38 publications

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

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

Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism

Paratireoidectomia: ainda a melhor escolha para o tratamento do hiperparatireoidismo secundário grave

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