Kidney transplantation and evolution of parathyroid function: results of a single-center study
https://doi.org/10.23873/2074-0506-2025-17-2-157-166
Abstract
Background. The functional status of the parathyroid glands (PTG) in patients with chronic kidney disease (CKD) before and after kidney transplantation (KT) is interrelated. The preoperative optimal blood level of parathyroid hormone (PTH) for the prevention of the post-transplant hyperparathyroidism (HPT) development is unknown.
The objective was to study the function of the PTG after KT during the first postoperative year depending on the pretransplant serum PTH level in the target range (150–600 pg/mL).
Material and methods. The retrospective cohort single-center study included 157 patients with preoperative blood PTH levels of 150–600 pg/mL who had undergone primary successful KT for CKD G5-G5(D) at least a year before inclusion in the study. Serum concentrations of PTH, calcium, adjusted for albumin, phosphorus, and creatinine were studied before KT and at 3 and 12 months after it. Blood PTH no more than 130 pg/mL was a target level after KT.
Results. Patients were allocated into three groups: 82 patients with blood PTH of 150–300 pg/mL were included into the 1st group; 41 patients with blood PTH of 301–450 pg/mL comprised the 2nd group, and 34 patients with blood PTH of 451–600 pg/mL made the 3rd group. Three months after KT, blood PTH decreased to 128 (98;169) pg/mL, 180 (121;222) pg/mL, and 247 (154;299) pg/mL (p<0.001) in the 1st, 2nd, and 3rd patient groups, respectively; the target blood PTH level was observed in 58.5%, 34.1%, and 20.6% of patients in the respective groups (p<0.001). No differences in the in PTG values were seen between the groups by the end of the year. A decrease in phosphorus and stable normal blood calcium were recorded. The graft function was similar in the patients of all groups throughout the year. A direct close correlation was established between blood PTH before KT and three months after KT, a less close one after one year; the relationship between blood PTH and graft function was weak after three months and a close one after one year.
Conclusion. The process of normalization of PTG function in the early stages after successful KT depends on the preoperative blood PTH level.
About the Author
O. N. Vetchinnikova
Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
Russian Federation
Olga N. Vetchinnikova - Dr. Sci. (Med.), Senior Research Associate, Kidney Transplantation Department
61/2 Shchepkin St., Moscow 129110
References
1. Messa P, Alfieri C. Secondary and tertiary hyperparathyroidism. Front Horm Res. 2019;51:91–108. PMID: 30641516 https://doi.org/10.1159/000491041
2. Cianciolo G, Galassi A, Capelli I, Angelini ML, Manna GL, Cozzolino M. Vitamin D in kidney transplant recipients: mechanisms and therapy. Am J Nephrol. 2016;43(6):397–407. PMID: 27229347 https://doi.org/10.1159/000446863
3. Garcia-Padilla PK, Quijano JE, Navarro K, Gonzalez CG. Behavior of bone mineral metabolism in renal posttransplantation patients with severe hyperparathyroidism. Transplant Proc. 2020;52(4):1143–1146. PMID: 32276835 https://doi.org/10.1016/j.transproceed.2020.01.055
4. Vetchinnikova ON. Hyperparathyroidism in kidney transplant candidates and postoperative parathyroid gland function in recipients. Russian Journal of Transplantology and Artificial Organs. 2024;26(2):82–93. (In Russ.). https://doi.org/10.15825/1995-1191-2024-2-82-93
5. Okada M, Sato T, Hasegawa Y, Futamura K, Hiramitsu T, Ichimori T, et al. Persistent hyperparathyroidism after preemptive kidney transplantation. Clin Exp Nephrol. 2023;27(10):882– 889. PMID: 37351681 https://doi.org/10.1007/s10157-023-02371-9
6. Wang R, Price G, Disharoon M, Stidham G, McLeod MC, McMullin JL, et al. Resolution of secondary hyperparathyroidism after kidney transplantation and the effect on graft survival. Ann Surg. 2023;278(3):366–375. PMID: 37325915 https://doi.org/10.1097/SLA.0000000000005946
7. Crepeau P, Chen X, Udyavar R, Morris-Wiseman LF, Segev DL, McAdams-DeMarco M, et al. Hyperparathyroidism at 1 year after kidney transplantation is associated with graft loss. Surgery. 2023;173(1):138–145. PMID: 36244806 https://doi.org/10.1016/j.surg.2022.07.031
8. Tsai M-H, Chen M, Liou H-H, Lee T-S, Huang Y-C, Liu P-Y, et al. Impact of pretransplant parathyroidectomy on graft survival: a comparative study of renal transplant patients (2005-2015). Med Sci Monit. 2023;29:e940959. PMID: 37525452 https://doi.org/10.12659/MSM.940959
9. Molinari P, Regalia A, Leoni A, Campise M, Cresseri D, Cicero E, et al. Impact of hyperparathyroidism and its different subtypes on long term graft outcome: a single Transplant Center cohort study. Front Med (Lausanne). 2023;10:1221086. PMID: 37636567 https://doi.org/10.3389/fmed.2023.1221086
10. Evenepoel P, Jørgensen HS. Skeletal parathyroid hormone hyporesponsiveness: a neglected, but clinically relevant reality in chronic kidney disease. Curr Opin Nephrol Hypertens. 2024;33(4):383– 390. PMID: 38651491 https://doi.org/10.1097/MNH.0000000000000992
11. National kidney foundation. K/ DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003;42(Suppl. 3):S1–S201. PMID: 14520607
12. Kidney Disease Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKDMBD). Kidney Int Suppl. 2009;113:S1– S130. PMID: 19644521 https://doi.org/10.1038/ki.2009.188
13. Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKDMBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7(3):e1. PMID: 30681074 https://doi.org/10.1016/j.kisu.2017.04.001
14. Хроническая болезнь почек (ХБП). Клинические рекомендации. Нефрология. 2021;25(5):10–82. Chronic kidney disease (CKD). Clinical recommendations. Nephrology (Saint-Petersburg). 2021;25(5):10–82. (In Russ.). https://doi.org/10.24884/1561-6274-2021-25-5-10-82
15. Zhou X, Guo Y, Luo Y. The optimal range of serum intact parathyroid hormone for a lower risk of mortality in the incident hemodialysis patients. Renal Failure. 2021;43(1):599–605. PMID: 33781171 https://doi.org/10.1080/0886022X.2021.1903927
16. Sprague SM, Bellorin-Font E, Jorgetti V, Carvalho AB, Malluche HH, Ferreira A, et al. Diagnostic accuracy of bone turnover markers and bone histology in patients with CKD treated by dialysis. Am J Kidney Dis. 2016;67:559– 566. PMID: 26321176 https://doi.org/10.1053/j.ajkd.2015.06.023
17. Perrin P, Caillard S, Javier RM, Braun L, Heibel F, Borni-Duval C, et al. Persistent hyperparathyroidism is a major risk factor for fractures in the five years after kidney transplantation. Am J Transplant. 2013;13(10):2653– 2663. PMID: 24034142 https://doi.org/10.1111/ajt.12425
18. Bleskestad IH, Bergrem H, Leivestad T, HartmannA, Gøransson LG. Parathyroid hormone and clinical outcome in kidney transplant patients with optimal transplant function. Clin Transplant. 2014;28(4):479–486. PMID: 25649861 https://doi.org/10.1111/ctr12341
19. Mehrotra S, Sharma RK, Patel MR. Vitamin D, 1,25-Dihydroxyvitamin D, FGF23 and graft function after renal transplantation. Indian J Nephrorgy. 2019;29(4):242–247. PMID: 31423057 https://doi.org/10.4103/ijn.IJN_307_18
20. Prasad N, Jaiswal A, Agarwal V, Kumar S, Chaturvedi S, Yadav S, et al. FGF23 is associated with early posttransplant hypophosphataemia and normalizes faster than iPTH in living donor renal transplant recipients: a longitudinal follow-up study. Clin Kidney J. 2016;9(5):669–676. PMID: 27679713 https://doi.org/10.1093/ckj/sfw065
21. Araujo MJCLN, Ramalho JAM, Elias RM, Jorgetti V, Nahas W, Custodio M, et al. Persistent hyperparathyroidism as a risk factor for long-term graft failure: the need to discuss indication for parathyroidectomy. Surgery. 2018;163(5):1144–1150. PMID: 29331397 https://doi.org/10.1016/j.surg.2017.12.010
22. Ma C, Shen C, Tan H, Chen Z, Ding Z, Zhao Y, et al. A novel nomogram for predicting the risk of persistent hyperparathyroidism after kidney transplantation. Endocrine. 2024;86(1):400–408. PMID: 39009921 https://doi.org/10.1007/s12020-024-03963-5
23. Lou I, Foley D, Odorico SK, Leverson G, Schneider DF, Sippel R, et al. How well does renal transplantation cure hyperparathyroidism. Ann Surg. 2015;262(4):653–659. PMID: 26366545 https://doi.org/10.1097/SLA.0000000000001431
24. Garcia-Montemayor V, Sánchez-Agesta M, Agüera ML, Calle Ò, Navarro MD, Rodríguez A, et al. Influence of pre-kidney transplant secondary hyperparathyroidism on later evolution after renal transplantation. Transplant Proc. 2019;51(2):344–349. PMID: 30879538 https://doi.org/10.1016/j.transproceed.2018.12.012
25. Perrin P, Kiener C, Javier R-M, Braun L, Cognard N, Gautier-Vargas G, et al. Recent changes in chronic kidney disease-mineral and bone disorders, and associated fractures after kidney transplantation. Transplantation. 2017;101(8):1897–1905. PMID: 27547867 https://doi.org/10.1097/TP.0000000000001449
26. Walkenhorst Z, Maskin A, Westphal S, Fingeret AL. Factors associated with persistent post-transplant hyperparathyroidism after index renal transplantation. J Surg Res. 2023;285:229235. PMID: 36709541 https://doi.org/10.1016/j.jss.2022.12.030
Review
For citations:
Vetchinnikova O.N. Kidney transplantation and evolution of parathyroid function: results of a single-center study. Transplantologiya. The Russian Journal of Transplantation. 2025;17(2):157-166. (In Russ.) https://doi.org/10.23873/2074-0506-2025-17-2-157-166
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