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Parathyroid function after successful renal transplantation

J F Botha¹, J R Botha

¹Department of Surgery, Johannesburg Hospital.

South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie

|August 1, 1997

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Parathyroid function normalizes in 56% of kidney transplant recipients with good renal function. However, 33% exhibit persistently high parathyroid hormone (PTH) levels, indicating potential post-transplant parathyroid dysfunction.

Area of Science:

Nephrology
Endocrinology
Transplantation Surgery

Background:

Post-renal transplant, assessing parathyroid function is crucial for patients achieving good renal function.
Persistent hyperparathyroidism can complicate long-term outcomes after kidney transplantation.

Purpose of the Study:

To evaluate parathyroid hormone (PTH) levels and calcium (Ca) status in kidney transplant recipients with stable, good renal function.
To identify the prevalence and patterns of parathyroid dysfunction post-renal transplantation.

Main Methods:

Retrospective analysis of 210 kidney transplant recipients with creatinine < 133 mumol/l.
Collected pre- and post-transplant data on calcium, albumin, creatinine, and parathyroid hormone (PTH).
Categorized patients into four groups based on PTH and Ca levels, excluding those with prior parathyroidectomy.

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Main Results:

56% of patients had normal calcium and PTH levels post-transplant.
33% showed persistently high PTH with normal calcium; 36% of these had high-normal calcium.
8% had persistent tertiary hyperparathyroidism (3° HPT) requiring parathyroidectomy.
Pre-transplant tertiary hyperparathyroidism was associated with poorer post-transplant PTH normalization (P < 0.059).

Conclusions:

Parathyroid function normalizes in over half of kidney transplant recipients with good renal function.
A significant proportion experience persistent hyperparathyroidism, suggesting a need for monitoring.
The severity of pre-transplant parathyroid disease is a predictor of post-transplant parathyroid status.