Patients with secondary hyperparathyroidism (SHPT) who have higher parathyroid hormone (PTH) levels prior to undergoing kidney transplantation are more likely to have higher postoperative PTH, despite more intense treatment.

Victoria García Montemayor, MD, and colleagues from the University Hospital Reina Sofía in Spain, studied 543 patients who received renal transplant at their institution. Overall, mean PTH declined from 241.14 pg/mL before transplantation to 115.7 pg/mL at 3 months and 112 pg/mL at 12 and 24 months. SHPT treatment was administered to 27.3% of patients prior to surgery, 40.4% at 3 months, 24.2% at 12 months, and 23.2% at 24 months. Transplant recipients who required hyperparathyroidism treatment before surgery were significantly more likely to require treatment afterward.

The team stratified patients into 3 groups by preoperative PTH to better understand the natural history of SHPT. Group 1 had PTH levels below 150 pg/mL; group 2, 150–300 pg/mL; and group 3, greater than 300 pg/mL. After transplant surgery, group 3 continued to display significantly higher PTH and required more postoperative treatment than the other groups. Further analysis showed that postoperative PTH related with preoperative PTH after adjusting for the glomerular filtration rate of the renal graft.

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“Higher pretransplantation levels of PTH are responsible for poor control of CKD-MBD [chronic kidney disease-mineral and bone disorder] after kidney transplantation,” Dr Montemayor and the team stated in Transplantation Proceedings.

They emphasized the need to establish adequate treatment for CKD-MBD in this population, such as the optimal timing of parathyroidectomy or calcimimetics.

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Garcia-Montemayor V, Sánchez-Agesta M, Agüera L, Calle MD, et al. Influence of pre-renal transplant secondary hyperparathyroidism on later evolution after transplantation. Trans Proceed. DOI:10.1016/j.transproceed.2018.12.012