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. 2015 Oct;262(4):653-9.
doi: 10.1097/SLA.0000000000001431.

How Well Does Renal Transplantation Cure Hyperparathyroidism?

Irene Lou  1 , David Foley, Scott K Odorico, Glen Leverson, David F Schneider, Rebecca Sippel, Herbert Chen
Affiliations

How Well Does Renal Transplantation Cure Hyperparathyroidism?

Irene Lou et al. Ann Surg. 2015 Oct.

Abstract

Background: Most patients with end-stage renal disease will develop hyperparathyroidism (HPT). Transplantation reportedly resolves HPT in most cases. Currently, guidelines recommend a watchful waiting approach to HPT for the first 12 months after the transplantation to allow maximal allograft function. The purpose of our study is to examine the incidence and impact of HPT, defined as an elevated parathyroid hormone (PTH) level, after renal transplantation in a contemporary cohort.

Methods: Primary kidney transplantation was performed on 1609 patients from January 1, 2004, to June 6, 2012. Patients were stratified by timing of achieving normal serum PTH levels, and a multivariate logistic regression was constructed to determine predictive variables. Kaplan-Meier analysis was then performed on overall graft survival based on PTH normalization.

Results: Four hundred eighty-eight (30.3%) patients achieved normal PTH within 1 year posttransplant. Four hundred twenty-seven (26.6%) attained normal PTH between 1 and 2 years, with the remaining 694 (43.1%) categorized as having HPT. Patients achieving normal PTH within 12 months of transplantation had a significantly longer median graft survival (7.33 years) compared with those patients who normalized between 12 and 24 months (4.92 years, P < 0.001), and those with HPT (5.13 years, P < 0.001). Comparing normalization of PTH by 2 years to HPT patients, obesity (P < 0.001), months on dialysis (P < 0.001), and delayed graft failure (P = 0.006) were predictive of nonnormalization. Overall, allograft survival analysis revealed a survival advantage for patients who normalize PTH within 24 months of transplantation (P = 0.038).

Conclusions: Renal transplant resolves HPT in 56.9% of patients at 2 years. Resolution within the first year portends longer graft survival. Therefore, earlier intervention for HPT should be considered.

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Conflict of interest statement

Conflicts of Interest

For the remaining authors, none are declared.

Figures

Figure 1
Figure 1. Flowchart of patient selection
PTH = parathyroid hormone, HPT = hyperparathyroidism, defined as an elevated serum PTH level
Figure 2
Figure 2. Median graft survival grouped by timing of parathyroid hormone resolution
ANOVA boxplot of graft survival grouped by timing of parathyroid hormone resolution
Figure 3
Figure 3. Kaplan Meier allograft survival curves A. Grouped by normalization at 24 months post-transplant B. Grouped by timing of PTH normalization
PTH = parathyroid hormone A. Long-term allograft survival by Kaplan-Meier estimate based on normalization of PTH. Reference line drawn at 5 years B. Long-term allograft survival by Kaplan-Meier estimate based on timing of PTH normalization. Reference line drawn at 5 years
Figure 4
Figure 4. Kaplan Meier estimate of overall patient survival based on normalization of PTH by 24 months post-transplant
PTH = parathyroid hormone, Kaplan-Meier estimate of long-term patient survival based on normalization of PTH. Reference line drawn at divergence, at 8.5 years
See this image and copyright information in PMC

Comment in

References

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