Risk Factors and Treatment Options for Persistent Hyperparathyroidism After Kidney Transplantation

Kidney transplantation (KT) corrects secondary hyperparathyroidism. However, persistent hyperparathyroidism (pHPT) may be observed in some patients post-KT. This study aims to evaluate the risk factors and treatment options for pHPT.

The study population comprises 1054 patients who underwent KT between January 2001 and May 2019. Serum samples were analyzed for calcium (Ca), phosphorus, creatinine, intact parathyroid hormone (iPTH) and estimated glomerular filtration rate.

The prevalence of pHPT following KT is 14%. Ninety pHPT patients were compared with 550 non-pHPT patients. The median duration of pre-KT dialysis was longer, and pre-KT serum Ca, P, and iPTH levels were significantly higher in the pHPT group than the non-HPT group. The pHPT of 46 patients (51%) received medical treatment. The remaining 44 patients (49%) had parathyroidectomy (PTx) if symptoms or signs (or both) of pHPT continued. Subtotal PTx was performed in 35 patients, and minimally invasive PTx was performed in 9 patients.

Based on our study results, the most important risk factors for post-KT pHPT are long dialysis duration and high pre-KT iPTH levels. In patients who underwent KT, if pHPT lasts longer than 1 year, surgical treatment is the recommended approach. Based on our experience, the treatment method to be performed in pHPT should be 3+1/2 PTx.