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

Abstract

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.

Pre-Transplant Hyperparathyroidism and Graft or Patient Outcomes After Kidney Transplantation

“…In contrast, another study with a smaller sample size did find that a higher pre-transplant plasma PTH level was associated with a higher risk of death-censored graft failure (DCGF), but not with DGF or premature mortality [ 26 ]. Our finding that PTH at 1 year post-transplant was associated with DCGF and mortality is in line with prior studies [ 27 – 29 ], underscoring the importance of closely monitoring PTH levels after kidney transplantation so that patients with persistent or new-onset HPT post-transplant can be treated appropriately. Furthermore, it is important to consider other outcomes beyond graft and patient outcomes.…”

Microscopic pore structure characteristics and controlling factors of marine shale: a case study of Lower Cambrian shales in the Southeastern Guizhou, Upper Yangtze Platform, South China

“…The characteristics of shale reservoirs are collectively controlled by organic matter (OM), inorganic mineral composition, their evolution, and diagenetic processes. The pore characteristics of shale reservoirs vary significantly under different geological conditions, exhibiting strong heterogeneity (Aplin et al, 2006;Bernard et al, 2012;Wang et al, 2018;Dowey and Taylor, 2020;Liu Y. et al, 2021;Wang et al, 2021a;Liu D. et al, 2021;Sun M. et al, 2022;Lai et al, 2022;Wang et al, 2023a;Wang et al, 2023b;Dong et al, 2023;Shi et al, 2023). Additionally, influenced by the unique geological conditions in China, shale gas in southern marine shale formations is significantly constrained by preservation conditions (Wang et al, 2016;Liu D. et al, 2021;Guo et al, 2022;Wu et al, 2022).…”

Treatment of Hypercalcemic Hyperparathyroidism After Kidney Transplantation Is Associated With Improved Allograft Survival

“… 10 However, secondary HPT can persist and become tertiary HPT post-KT. 11 Tertiary HPT is caused by autonomous function of multiple hyperplastic parathyroid glands, characterized by elevated parathyroid hormone (PTH) levels with hypercalcemia or normocalcemia. 12 Persistent HPT post-KT carries a significant clinical burden and is underdiagnosed and undertreated.…”