Early development of secondary hyperparathyroidism following renal transplantation

Optimal levels of intact parathyroid hormone (iPTH) in the post-transplant period are not known due to insufficient data. Therefore, we aimed to describe secondary hyperparathyroidism (SHPT) in Swedish renal transplant (RT) recipients and also report events of fractures and vascular events potentially related to levels of iPTH.

Medical charts from 132 RT recipients were retrospectively reviewed. Laboratory/clinical data were obtained at regular points up to 12 months post RT. Three groups were created based on pre-RT levels of iPTH based on KDOQI recommended levels of iPTH in CKD 5.

One year post RT 69% had iPTH above levels recommended by KDOQI. A multiple regression analysis showed a strong relation between pre-transplant iPTH levels and iPTH levels at 12 months (β coefficient = 0.323, p < 0.001). Patients with low pre-transplant levels of iPTH had a higher rate of fractures during follow up compared to patients with higher pre-transplant levels of iPTH (P = 0.034) [corrected].

SHPT is common in Swedish RT recipients. Pre-transplant regulation of SHPT is of great importance to determine outcome post RT. Low levels of iPTH in the pre-transplant period could be associated with a high risk of fracture in the first post-transplant year.