Saudi Journal of Kidney Diseases and Transplantation

ORIGINAL ARTICLE
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

Correspondence Address:
Tarik Sqalli Houssaini
Service de Nephrologie, Dialyse, Transplantation, CHU Ibn Sina, Rabat, Maroc
Morocco

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.



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


Full Text

 Introduction



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).

 Results



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



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

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