Abstract: TH-PO1000

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

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Alfieri, Carlo M., Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Gandolfo, Maria Teresa, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Binda, Valentina, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Cresseri, Donata, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Campise, Mariarosaria, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Regalia, Anna, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Meneghini, Maria, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
  • Messa, Piergiorgio, Fondazione IRCCS Ca' Granda Ospedale Policlinico Milan, Milan, Italy
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 1styear 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 1st 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 1st 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 1st year rejection prevalence was found (p=0.001) between the two groups. In multivariate analysis only iPTH at 1st mth and not iPTH at 12th mth resulted independently related with graft loss(p=0.03).
Using ROC curve, the the discriminatory power in predicting graft outcome was tested for: 1st mth eGFR (AUC 0.37±0.04 – p=0.003), 1st mth Prot-U(AUC 0.62±0.04 – p=0.002) and 1st 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.