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Evaluating Hyperparathyroidism in Simultaneous Pancreas-Kidney Transplant Recipients: A Single-Center Experience
Lane T Cavey1, Lindsay A Kohan1, Ruchin Patel2
1University of Maryland School of Medicine, Baltimore, Maryland, USA.
Insights
Tertiary hyperparathyroidism (3HPT) after pancreas-kidney transplants is linked to poorer graft function and increased peripheral arterial disease. Further research is needed to establish causality and guide treatment for 3HPT in these patients.
Area of Science:
- Nephrology
- Transplantation Immunology
- Endocrinology
Background:
- Cardiovascular disease is a leading cause of mortality in kidney transplant recipients.
- Hyperparathyroidism (HPT) may accelerate cardiovascular disease, especially in patients with renal failure and diabetes.
- Limited data exist on managing tertiary hyperparathyroidism (3HPT) in simultaneous pancreas-kidney (SPK) transplant recipients.
Purpose of the Study:
- To evaluate the impact of HPT on cardiovascular disease, bone health, and graft function in SPK transplant recipients.
- To compare outcomes between SPK patients with resolved HPT and those who developed 3HPT.
Main Methods:
- Retrospective review of 132 SPK transplant recipients at an academic center.
- Categorization of patients into resolved HPT and unresolved HPT (3HPT) groups.
- Bivariate comparisons using independent group t-tests and Fisher's exact tests.
Main Results:
- 58.3% of SPK recipients developed 3HPT.
- Patients with 3HPT showed significantly lower eGFR and higher HbA1c at 3 years post-transplant.
- All patients exhibited worsening large vessel calcifications, with 3HPT associated with peripheral arterial disease.
Conclusions:
- 3HPT in SPK transplant recipients is associated with impaired renal and pancreatic graft function and increased peripheral arterial disease.
- Further prospective studies are required to confirm these findings and establish treatment guidelines for 3HPT.
Introduction:
Cardiovascular disease remains the primary cause of mortality after kidney transplantation. Hyperparathyroidism (HPT) may contribute to the accelerated progression of coronary artery disease (CAD) and peripheral artery disease (PAD), particularly in transplant patients. This is particularly true when HPT overlaps with both renal failure and diabetes. Scant data exist to support medical or surgical management of tertiary hyperparathyroidism (3HPT) in simultaneous pancreas-kidney (SPK) transplant recipients. This study evaluates the outcomes of cardiovascular disease, bone health, and kidney and pancreas graft function as they relate to HPT in SPK recipients.
Methods:
Patients who received SPK transplantation at a large academic center were reviewed. Patient demographics, transplant specifics, evidence of HPT, graft survival, and mortality were collected. Patients were categorized as either resolved HPT or unresolved HPT (developed 3HPT). Independent group t-tests and Fisher's exact tests were used for bivariate comparisons.
Results:
Over 7 years, 132 patients received SPK transplantation. 41.7% of patients resolved HPT, and 58.3% of patients developed 3HPT. Those with 3HPT had significantly lower eGFR at 3 years (51.16 ± 21.58 vs. 62.55 ± 19.56 mL/min/1.73m2, p = 0.009) and higher HbA1c (6.05 ± 1.56 vs. 5.61 ± 0.83, p = 0.047). All patients experienced worsening radiographic evidence of large vessel calcifications (p < 0.001).
Conclusions:
3HPT after SPK transplant is associated with worse function of both the renal and pancreatic grafts and peripheral arterial disease compared to those without 3HPT. A larger prospective cohort study is needed to determine causal relationships and develop treatment guidelines.
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