Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 7:37:11916.
doi: 10.3389/ti.2024.11916. eCollection 2024.

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

Fernanda Guedes Rodrigues  1   2 , Willemijn Y Van Der Plas  3   4 , Camilo German Sotomayor  1 , Amarens Van Der Vaart  5 , Daan Kremer  1 , Robert A Pol  3 , Schelto Kruijff  3   6   7 , Ita Pfeferman Heilberg  2   8 , Stephan J L Bakker  1 ; TransplantLines Investigators; Martin H De Borst  1
Affiliations

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

Fernanda Guedes Rodrigues et al. Transpl Int. .

Abstract

The impact of pre-transplant parathyroid hormone (PTH) levels on early or long-term kidney function after kidney transplantation is subject of debate. We assessed whether severe hyperparathyroidism is associated with delayed graft function (DGF), death-censored graft failure (DCGF), or all-cause mortality. In this single-center cohort study, we studied the relationship between PTH and other parameters related to bone and mineral metabolism, including serum alkaline phosphatase (ALP) at time of transplantation with the subsequent risk of DGF, DCGF and all-cause mortality using multivariable logistic and Cox regression analyses. In 1,576 kidney transplant recipients (51.6 ± 14.0 years, 57.3% male), severe hyperparathyroidism characterized by pre-transplant PTH ≥771 pg/mL (>9 times the upper limit) was present in 121 patients. During 5.2 [0.2-30.0] years follow-up, 278 (15.7%) patients developed DGF, 150 (9.9%) DCGF and 432 (28.6%) died. A higher pre-transplant PTH was not associated with DGF (HR 1.06 [0.90-1.25]), DCGF (HR 0.98 [0.87-1.13]), or all-cause mortality (HR 1.02 [0.93-1.11]). Results were consistent in sensitivity analyses. The same applied to other parameters related to bone and mineral metabolism, including ALP. Severe pre-transplant hyperparathyroidism was not associated with an increased risk of DGF, DCGF or all-cause mortality, not supporting the need of correction before kidney transplantation to improve graft or patient survival.

Keywords: delayed graft function; graft survival; hyperparathyroidism; kidney transplantation; mineral metabolism.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Forest plot showing associations between pre-transplant plasma PTH level (per doubling) and delayed graft function (DGF) according to parameters at time of transplantation. In total, 278 (16.7%) kidney transplant recipients developed DGF. Abbreviations: N, number; Tx, transplant; ALP, alkaline phosphatase; HR, hazard ratio.
FIGURE 2
FIGURE 2
Association of pre-transplant plasma PTH with risk of (A) DCGF and (B) all-cause mortality. The solid lines represent the fully adjusted hazard ratios (HRs) for DCGF (Cox regression Model 2) and all-cause mortality (Cox regression Model 2). The grey areas represent the 95% confidence intervals of the HRs.
FIGURE 3
FIGURE 3
Forest plot showing associations between pre-transplant plasma PTH levels (per doubling) and death censored graft function (DCGF) according to parameters at time of transplantation. In total, 150 (9.9%) kidney transplant recipients developed DCGF. Abbreviations: N, number; Tx, transplant; ALP, alkaline phosphatase; HR, hazard ratio.
FIGURE 4
FIGURE 4
Distribution of proportion of patients with median plasma (A) PTH (B) calcium and (C) phosphate within, below or above the reference range for the first 24 months after kidney transplantation. Values are expressed as percentages. Abbreviations: PTH, parathyroid hormone; PTx, parathyroidectomy.
See this image and copyright information in PMC

References

    1. Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, et al. Prevalence of Abnormal Serum Vitamin D, PTH, Calcium, and Phosphorus in Patients With Chronic Kidney Disease: Results of the Study to Evaluate Early Kidney Disease. Kidney Int (2007) 71(1):31–8. 10.1038/sj.ki.5002009 - DOI - PubMed
    1. Tentori F, Blayney MJ, Albert JM, Gillespie BW, Kerr PG, Bommer J, et al. Mortality Risk for Dialysis Patients With Different Levels of Serum Calcium, Phosphorus, and PTH: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis (2008) 52(3):519–30. 10.1053/j.ajkd.2008.03.020 - DOI - PubMed
    1. Kalantar-Zadeh K, Kuwae N, Regidor DL, Kovesdy CP, Kilpatrick RD, Shinaberger CS, et al. Survival Predictability of Time-Varying Indicators of Bone Disease in Maintenance Hemodialysis Patients. Kidney Int (2006) 70(4):771–80. 10.1038/sj.ki.5001514 - DOI - PubMed
    1. Bozic M, Diaz-Tocados JM, Bermudez-Lopez M, Forné C, Martinez C, Fernandez E, et al. Independent Effects of Secondary Hyperparathyroidism and Hyperphosphataemia on Chronic Kidney Disease Progression and Cardiovascular Events: An Analysis From the NEFRONA Cohort. Nephrol Dial Transplant (2022) 37(4):663–72. 10.1093/ndt/gfab184 - DOI - PubMed
    1. Evenepoel P, Claes K, Kuypers DR, Debruyne F, Vanrenterghem Y. Parathyroidectomy After Successful Kidney Transplantation: A Single Centre Study. Nephrol Dial Transpl (2007) 22(6):1730–7. 10.1093/ndt/gfm044 - DOI - PubMed