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How Well Does Renal Transplantation Cure Hyperparathyroidism?
Irene Lou*, Scott Odorico*, David Foley*, David Schneider*, Rebecca Sippel*, Herbert Chen
University of Wisconsin-Madison, Madison, WI

Background:
Most patients with end-stage kidney disease will develop renal hyperparathyroidism. Transplantation reportedly resolves secondary hyperparathyroidism in 95% of cases. Therefore, current practice guidelines recommend a watchful waiting approach to hyperparathyroidism the first 12 months after transplantation to allow maximal allograft function. The purpose of our study is to examine the incidence of hyperparathyroidism, defined as an elevated parathyroid hormone (PTH) level, after renal transplantation in a contemporary cohort.
Method: A total of 2,039 patients underwent kidney transplantation from 1/1/2004-6/30/2012 with a minimum of 24 months of follow-up. One-way analysis of variance was used to compare group means. A multivariate logistic regression model was constructed, with significance at p<0.05.
Results:
603 (30%) of patients achieved normal PTH within the first year. 659 (32%) attained normal PTH after one year, with the remaining 777 (38%) having recurrent or persistent hyperparathyroidism (RPH). Patients normalizing PTH within 12 months had a longer mean graft-survival (6.9±0.1 years) compared to those with delayed PTH normalization (5.35±0.08 years) and those with RPH (5.08±0.07 years), p<0.001. There was no statistically significant difference in graft-survival between those with delayed normalization of PTH and those with RPH (p=0.054). Factors predictive of RPH include age at transplant (p=0.025), obesity (p<0.001), time on dialysis pre-transplant (p<0.001) and delayed graft failure (p=0.02) defined as requiring dialysis within 7 days of transplantation.
Conclusion:
Renal transplant resolves hyperparathyroidism in only 62% of patients. Resolution within the first year portends longer graft-survival, therefore consideration of earlier intervention for hyperparathyroidism is warranted.


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