Kidney Week

Abstract: TH-PO1000

High Levels of Parathyroid Hormone after One Month of Renal Transplantation Are Related to Long Term Graft Loss

Session Information

• Transplant Recipient Education, Adherence, and Novel Risk Factors for Graft Loss
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Alfieri, Carlo M., Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Carlo M. Alfieri,

• Gandolfo, Maria Teresa, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Maria Teresa Gandolfo,

• Binda, Valentina, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Valentina Binda,

• Cresseri, Donata, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Donata Cresseri,

• Campise, Mariarosaria, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Mariarosaria Campise,

• Regalia, Anna, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Anna Regalia,

• Meneghini, Maria, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Maria Meneghini,

• Messa, Piergiorgio, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy

Piergiorgio Messa,

Background

Renal transplantation (RTx) only partially corrects certain metabolic alterations, especially in mineral metabolism (MM). Our aim was to examine the effect of RTx during the 1^styear of RTx on MM parameters and to evaluate the factors mostly related to long term graft outcome.

Methods

In 531 RTx pts (age:48[39;58]yrs–303males), transplanted in our unit between 2004 and 2014, clinical parameters, blood and urinary samples were collected before RTx and at 1, 6, 12 mths after RTx. Median follow up was 7[2-12]yrs.

Results

84% of pts received a RTx from a deceased donor; 72% and 20% of pts were treated with haemodialysis and peritoneal dialysis before RTx. Time of dialysis was 48[30-71]mths. In the overall cohort MM parameters before RTx were: Ca 9.3[8.8-9.8] mg/dL, P 5.0[4.05-5.85] mg/dL, iPTH 205[123-443]pg/mL, ALP 106[66-170] U/L. Cold ischemia time (CT) was 13[11-16]h. In 13% of pts DGF was reported, and 13% of pts had a rejection during the 1^st year of RTx.
During the 1st year of RTx,6% of pts received cinacalcet. Thirty-five% of pts were treated with active vitamin D, whereas in 11 % were supplemented with natural vitamin D alone. In the 1^st year of RTx, a reduction of iPTH levels was observed(p=0.005). During follow up time, 66 pts restarted dialysis (D+). Compared to pts with a functioning graft (D-), D+ had longer CT(p=0.01) and at the 3-timepoints considered, worst renal function, higher urinary protein excretion and of iPTH. A difference in 1^st year rejection prevalence was found (p=0.001) between the two groups. In multivariate analysis only iPTH at 1^st mth and not iPTH at 12^th mth resulted independently related with graft loss(p=0.03).
Using ROC curve, the the discriminatory power in predicting graft outcome was tested for: 1^st mth eGFR (AUC 0.37±0.04 – p=0.003), 1^st mth Prot-U(AUC 0.62±0.04 – p=0.002) and 1^st mth iPTH (AUC 0.62±0.05 – p=0.01 – cut-off value 75 pg/mL). The inclusion of iPTH to eGFR and Prot-U provided an increase in discriminatory power which was +30% for eGFR + iPTH (AUC from 0.37 to 0.67 –p<0.001) and +3% for Prot-U + iPTH (AUC from 0.62 to 0.65 –p=0.002).

Conclusion

Our data confirm that RTx is able to influence MM from the beginning, and that early elevated iPTH levels at 1st month of RTx may play a role on long-term graft outcome.