Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 233 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 


 
ORIGINAL ARTICLE Table of Contents   
Year : 2008  |  Volume : 19  |  Issue : 3  |  Page : 401-403
Predictors of Hyperparathyroidism in Renal Transplant Recipients


Service de Nephrologie, Dialyse, Transplantation, CHU Ibn Sina, Rabat, Maroc, Morocco

Click here for correspondence address and email
 

   Abstract 

The changes in parathyroid hormone secretion after successful renal transplantation remain to be clearly elucidated. Our study was aimed at identifying the predictors of hyperpara­thyroidism in renal transplant recipients. A retrospective single center study involving 37 renal transplant recipients, with a follow-up of at least one year, was performed. All transplants were performed using kidneys from living related donors. The average age of the study patients was 30 ± 10 years, with a male-female ratio of 1.31. The mean duration on hemodialysis (HD) prior to transplantation was 25 ± 18 months. All the grafts but one, were functional after a mean follow-up of 41 ± 21 months. We noted a rapid reduction of the mean parathyroid hormone (iPTH) level from 383 ± 265 pg/ml before transplantation to 125 ± 67 pg/ml at one year and 108 ± 66 pg/ml at two years after transplantation (p = 0.01). Bivariate analysis revealed that the level of iPTH obtained during follow-up correlated with the duration on HD (p = 0.03), the serum creatinine at 24-months (p = 0.013), and to the level of iPTH in the first year post­transplantation (p = <0.001). Other clinical or laboratory parameters were not predictive of hyperpara­thyroidism after kidney transplantation. Linear regression showed that only the serum creatinine at 24­months independently correlated with the level of iPTH at last follow-up (p = 0.02). Our study suggests that short duration on HD and a functional graft are the main predictors of correction of hyperparathyroidism after renal transplantation.

Keywords: Hyperparathyroidism, Kidney transplantation, Parathyroid hormone

How to cite this article:
Houssaini TS, Arrayhani M, Rhou H, Amar Y, Benamar L, Ouzeddoun N, Bayahia R. Predictors of Hyperparathyroidism in Renal Transplant Recipients. Saudi J Kidney Dis Transpl 2008;19:401-3

How to cite this URL:
Houssaini TS, Arrayhani M, Rhou H, Amar Y, Benamar L, Ouzeddoun N, Bayahia R. Predictors of Hyperparathyroidism in Renal Transplant Recipients. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2019 Aug 17];19:401-3. Available from: http://www.sjkdt.org/text.asp?2008/19/3/401/40500

   Introduction Top


Hyperparathyroidism is a common problem in patients with renal failure, which could persist after renal transplantation despite the cor­rection of the causative factors. The aim of this study is to identify the predictors of persistence of hyperparathyroidism after renal transplantation.


   Patients and Methods Top


A retrospective single center study, involving 37 renal transplant recipients, with a follow-up of at least one year was performed. The organ source in all was from living related donors. We studied various clinical and bio­chemical parameters to determine which of them could predict the persistence of hyper­parathyroidism at one-year post transplan­tation, using bivariate analysis and linear regression. All statistics were calculated with SPSS (version 12.0, SPSS, Chicago, Ill).


   Results Top


The mean age of the study patients was 30 ± 10 years, male-female sex ratio was 1.31 and the mean duration on HD prior to trans­plantation was 25 ± 18 months. After a mean follow-up of 41 ± 21 (12-82) months, all the grafts but one were functioning normally. At the time of transplantation, the serum parathyroid hormone (iPTH) levels were above 300 pg/ml in 60%, 150-300 pg/ml in 17%, and less than 150 pg/ml in 23% of the patients. Following transplan­tation, we noticed a rapid fall of the mean iPTH levels from 383 ± 265 pg/ml before transplantation to 125 ± 67 pg/ml at one year and 108 ± 66 pg/ml at two years post­transplant follow-up (p = 0.01). We compared the iPTH levels after renal transplantation between patients with pre-existing hyper­parathyroidism and those with normal range iPTH levels during dialysis [Figure - 1]. Both groups decreased the iPTH levels to have the same levels of iPTH by the first year post-transplantation.

On bivariate analysis, the level of iPTH obtained at last follow-up correlated with the duration on HD (p = 0.03) and serum crea­tinine at 24-months (p = 0.013). On the other hand, no correlation was found with the level of iPTH just before renal transplan­tation, the age of the patient or the dose or type of immunosuppressive drugs. Linear regression showed that only the serum crea­tinine at 24-months independently corre­lated with the iPTH level at last follow-up (p = 0.02).


   Discussion Top


Secondary hyperparathyroidism is a fre­quent complication of chronic kidney disease. Renal transplantation corrects the bioche­mical abnormalities that cause hyperparathy­roidism. However, hyperparathyroidism per­sists in some patients. The changes in iPTH secretion after successful renal transplan­tation remain to be elucidated. [1]

In our study, the serum creatinine at 24­months after transplantation and longer dura­tion on HD prior to transplantation, were the strongest predictors of persistent hyperpara­thyroidism. It is comparable to the results published by Boudville et al [2],[3] who found that 25-hydroxyvitamin D concentrations also predict iPTH levels in renal transplant patients. Other baseline clinical or laboratory parameters were not predictive of hyper­parathyroidism after kidney transplantation.

Given the potential morbidities associated with persistent hyperparathyroidism, [4],[5] the role of interventions that would prevent or reverse persistent hyperparathyroidism post­transplantation require further investigation. [6]

 
   References Top

1.Roe SD, Porter CJ, Godber IM, Hosking DJ, Cassidy MJ. Reduced bone mineral density in male renal transplant recipients: Evidence for persisting hyperparathyroi­dism. Osteoporos Int 2005;16(2):142-8.  Back to cited text no. 1    
2.Boudville NC, Hodsman AB. Renal function and 25-hydroxyvitamin D concentrations predict parathyroid hormone levels in renal transplant patients. Nephrol Dial Transplant 2006;21(9):2621-4.  Back to cited text no. 2    
3.Matsuda-Abedini M, Portale AA, Shah A, Neuhaus J, McEnhill M, Mathias RS. Persistent secondary hyperparathyroidism after renal transplantation in children. Pediatr Nephrol 2006;21(3):413-8.  Back to cited text no. 3    
4.Pajda M, Matug A, Widlak M, et al. Influence of parathyroidectomy on blood pressure and function of the transplanted kidney in patients with tertiary hyperpara­thyroidism. Ann Transplant 2006;11(1):11-5.  Back to cited text no. 4    
5.Lomonte C, Antonelli M, Vernaglione L, et coll. Are low plasma levels of 25-(OH) vitamin D a major risk factor for hyper­parathyroidism independent of calcitriol in renal transplant patients? J Nephrol 2005;18 (1):96-101.  Back to cited text no. 5    
6.Apostolou T, Kollia K, Damianou L, et al. Hypercalcemia due to resistant hyperpara­thyroidism in renal transplant patients treated with the calcimimetic agent cina­calcet. Transplant Proc 2006;38(10):3514-6.  Back to cited text no. 6    

Top
Correspondence Address:
Tarik Sqalli Houssaini
Service de Nephrologie, Dialyse, Transplantation, CHU Ibn Sina, Rabat, Maroc
Morocco
Login to access the Email id


PMID: 18445900

Rights and Permissions


    Figures

  [Figure - 1]

This article has been cited by
1 Therapeutic management of post-kidney transplant hyperparathyroidism
Copley, J.B. and Wüthrich, R.P.
Clinical Transplantation. 2011; 25(1): 24-39
[Pubmed]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
    Article Figures
 

 Article Access Statistics
    Viewed2360    
    Printed78    
    Emailed0    
    PDF Downloaded339    
    Comments [Add]    
    Cited by others 1    

Recommend this journal