Vitamin D and Cinacalcet Administration Pre-transplantation Predict Hypercalcaemic Hyperparathyroidism Post-transplantation: a Case-control Study of 355 Deceased-donor Renal Transplant Recipients over 3 years

Overview

Journal Transplant Res

Publisher Biomed Central

Specialty General Surgery

Date 2015 Jan 22

PMID 25606342

Citations 3

Authors

Frank-Peter Tillmann

Carolin Wachtler

Anita Hansen

Lars Christian Rump

Ivo Quack

Affiliations

Soon will be listed here.

Abstract

Background: The effects of pre-transplantation medication for secondary hyperparathyroidism on post-transplantation parathyroid hormone (PTH) and calcium levels have not yet been conclusively determined. Therefore, this study sought to determine the level of off-label use of cinacalcet and to determine predictors of its administration during the long-term follow-up of a cohort of individuals who received deceased-donor renal transplants. Furthermore, safety considerations concerning the off-label use of cinacalcet are addressed.

Methods: This was a case-control study of 355 stable renal transplant recipients. The patient cohort was divided into two groups. Transplant group A comprised patients who did not receive cinacalcet treatment, and transplant group B comprised patients who received cinacalcet treatment during follow-up after renal transplantation. The characteristics of the patients were evaluated to determine predictors of cinacalcet use after successful renal transplantation.

Results: Compared with the control individuals (n = 300), the cinacalcet-treated individuals (n = 55) had significantly higher PTH levels at 4 weeks post-transplantation (20.3 ± 1.6 versus 40.7 ± 4.0 pmol/L, p = 0.0000) when they were drug naive. At 3.2 years post-transplantation, cinacalcet-treated patients showed higher PTH (26.2 ± 2.3 versus 18.4 ± 2.3 pmol/L, p = 0.0000), higher calcium (2.42 ± 0.03 versus 2.33 ± 0.01 mmol/L, p = 0.0045) and lower phosphate (0.95 ± 0.04 versus 1.06 ± 0.17 mmol/L, p = 0.0021) levels. Individuals in the verum group were more likely to receive cinacalcet therapy (45.5% versus 14.3%, p = 0.0000), and they had higher pill burdens for the treatment of hyperparathyroidism (1.40 ± 0.08 versus 0.72 ± 0.03 pills per patient, p = 0.0000) whilst they were on the waiting list for transplantation. Regression analysis confirmed the associations between hypercalcaemic hyperparathyroidism and PTH levels at 4 weeks post-transplantation (p = 0.0001), cinacalcet use (p = 0.0000) and the preoperative total pill burden (p = 0.0000). Renal function was the same in both groups.

Conclusions: Parathyroid gland dysfunction pre-transplantation translates into clinically relevant hyperparathyroidism post-transplantation, despite patients being administered more intensive treatment whilst on dialysis. PTH levels at 4 weeks post-transplantation might serve as a marker for the occurrence of hypercalcaemic hyperparathyroidism during follow-up.

Citing Articles

Impact of Pre-Transplant Parathyroidectomy on Graft Survival: A Comparative Study of Renal Transplant Patients (2005-2015).

Tsai M, Chen M, Liou H, Lee T, Huang Y, Liu P Med Sci Monit. 2023; 29:e940959.

PMID: 37525452 PMC: 10403992. DOI: 10.12659/MSM.940959.

Systematic Review of the Treatment of Persistent Hyperparathyroidism Following Kidney Transplantation.

Miedziaszczyk M, Lacka K, Tomczak O, Bajon A, Primke M, Idasiak-Piechocka I Biomedicines. 2023; 11(1).

PMID: 36672533 PMC: 9855347. DOI: 10.3390/biomedicines11010025.

Causes of hypercalcemia in renal transplant recipients: persistent hyperparathyroidism and others.

Moyses-Neto M, Garcia T, Nardin M, Muglia V, Molina C, Romao E Braz J Med Biol Res. 2021; 54(6):e10558.

PMID: 33909856 PMC: 8075129. DOI: 10.1590/1414-431X202010558.

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