Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study

Abstract

Kidney transplant recipients with a high iPTH and calcium x phosphate product at the time of transplantation are at risk for persistent HPT especially when renal function is suboptimal. Therapy for persistent HPT, if considered, should be initiated 3 months post-transplantation since further spontaneous improvement of parathyroid function thereafter is limited.

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

“…Many published studies do not report the level of vitamin D [109] and use different thresholds to define hypercalcaemia, sometimes using ionized calcium, total calcium levels or corrected calcium levels [107]. Dialysis patients require intensive medical therapy [7] to compensate for hypocalcaemia, hyperphosphoraemia and lack of vitamin D; and nephrologists often hesitate to discuss surgery before a long-standing medical treatment history evolves refractory.…”

“…After successful renal transplantation, PTH level decreases with a two-phase decline, first with a rapid drop until to 3 to 6 months [106,109,120,121] and second with a low decline up to 1 year [109] (EL 1). Approximately 25 % of patients presented with persistent renal HPT after this time [97,122,123], and hypocalcaemia episodes were observed in 30 % of patients at 1 year and in about 10 % at 5 years according to a study on 1165 patients [109].…”

“…Approximately 25 % of patients presented with persistent renal HPT after this time [97,122,123], and hypocalcaemia episodes were observed in 30 % of patients at 1 year and in about 10 % at 5 years according to a study on 1165 patients [109].…”

“…Many studies tried to define criteria [106,109,124,125] for predicting the occurrence of persistent hyperparathyroidism despite successful renal transplantation, probably reflecting the severity of nodular parathyroid hyperplasia. The most commonly recognized criteria were prolonged renal failure before and after dialysis (EL 3), highly elevated levels of PTH (EL 3), serum calcium and phosphorus levels, and large parathyroid glands observed on ultrasonography (EL 4).…”

“…Therefore, a delay of 3 months should be considered in case of severe HPT and 1 year in the case of persistent HPT [106,109,116,135] (RG C). A serum calcium level greater than 11.5 mg/dl, unexplained renal function deterioration or a progressive bone mineral density loss underscore arguments for PTX (RG C).…”