Year : 2008 | Volume
: 19 | Issue : 3 | Page : 401--403
Predictors of Hyperparathyroidism in Renal Transplant Recipients
Tarik Sqalli Houssaini, Mohamed Arrayhani, Hakima Rhou, Yamama Amar, Loubna Benamar, Naima Ouzeddoun, Rabea Bayahia
Service de Nephrologie, Dialyse, Transplantation, CHU Ibn Sina, Rabat, Maroc, Morocco
Tarik Sqalli Houssaini
Service de Nephrologie, Dialyse, Transplantation, CHU Ibn Sina, Rabat, Maroc
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.
|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;19:401-403
|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 2022 Jan 21 ];19:401-403
Available from: https://www.sjkdt.org/text.asp?2008/19/3/401/40500
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
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).
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).
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. 
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 , 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, , the role of interventions that would prevent or reverse persistent hyperparathyroidism posttransplantation require further investigation. 
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