Hyperparathyroidism at 1 Year After Kidney Transplantation is Associated with Graft Loss

Overview

Journal Surgery

Specialty General Surgery

Date 2022 Oct 16

PMID 36244806

Authors

Philip Crepeau

Xiaomeng Chen

Rhea Udyavar

Lilah F Morris-Wiseman

Dorry L Segev

Mara McAdams-DeMarco

Aarti Mathur

Affiliations

Soon will be listed here.

Abstract

Background: Hyperparathyroidism persists in many patients after kidney transplantation. The purpose of this study was to evaluate the association between post-transplant hyperparathyroidism and kidney transplantation outcomes.

Methods: We identified 824 participants from a prospective longitudinal cohort of adult patients who underwent kidney transplantation at a single institution between December 2008 and February 2020. Parathyroid hormone levels before and after kidney transplantation were abstracted from medical records. Post-transplant hyperparathyroidism was defined as parathyroid hormone level ≥70 pg/mL 1 year after kidney transplantation. Cox proportional hazards models were used to estimate the adjusted hazard ratios of mortality and death-censored graft loss by post-transplant hyperparathyroidism. Models were adjusted for age, sex, race/ethnicity, college education, parathyroid hormone level before kidney transplantation, cause of kidney failure, and years on dialysis before kidney transplantation. A Wald test for interactions was used to evaluate the risk of death-censored graft loss by age, sex, and race.

Results: Of 824 recipients, 60.9% had post-transplant hyperparathyroidism. Compared with non-hyperparathyroidism patients, those with post-transplant hyperparathyroidism were more likely to be Black (47.2% vs 32.6%), undergo dialysis before kidney transplantation (86.9% vs 76.6%), and have a parathyroid hormone level ≥300 pg/mL before kidney transplantation (26.8% vs 9.5%) (all P < .001). Patients with post-transplant hyperparathyroidism had a 1.6-fold higher risk of death-censored graft loss (adjusted hazard ratio = 1.60, 95% confidence interval: 1.02-2.49) compared with those without post-transplant hyperparathyroidism. This risk more than doubled in those with parathyroid hormone ≥300 pg/mL 1 year after kidney transplantation (adjusted hazard ratio = 4.19, 95% confidence interval: 1.95-9.03). The risk of death-censored graft loss did not differ by age, sex, or race (all P > .05). There was no association between post-transplant hyperparathyroidism and mortality.

Conclusion: The risk of graft loss was significantly higher among patients with post-transplant hyperparathyroidism when compared with patients without post-transplant hyperparathyroidism.

Citing Articles

Secondary Hyperparathyroidism and Cognitive Decline.

Crepeau P, Fedorova T, Morris-Wiseman L, Mathur A Curr Transplant Rep. 2024; 10(2):60-68.

PMID: 38707996 PMC: 11068066. DOI: 10.1007/s40472-023-00394-5.

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

Rodrigues F, van der Plas W, Sotomayor C, Van der Vaart A, Kremer D, Pol R Transpl Int. 2024; 37:11916.

PMID: 38384325 PMC: 10880800. DOI: 10.3389/ti.2024.11916.

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

Wang R, Reed R, Price G, Abraham P, Lewis M, McMullin J Oncologist. 2023; 29(4):e467-e474.

PMID: 38006197 PMC: 10994253. DOI: 10.1093/oncolo/oyad314.

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