Abstract: SA-PO1064
Management Patterns of Post-Kidney Transplant Hyperparathyroidism
Session Information
- Transplantation: Clinical - Postkidney Transplant Outcomes and Potpourri
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Maxey, Lucas N., University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Akers, Haley M, University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Freibert, Hannah, University of Kentucky College of Medicine, Lexington, Kentucky, United States
- Rao, Madhumathi, University of Kentucky Department of Internal Medicine, Lexington, Kentucky, United States
Background
Chronic kidney disease-mineral and bone disorder (CKD-MBD) related biochemical abnormalities improve after transplant, but hyperparathyroidism (HPT) can persist as either secondary or tertiary HPT. Despite the significant burden of post-transplant HPT, guidelines for its management are ill-defined. The present retrospective study describes the burden, clinical characteristics, and management of post-transplant HPT, including prevalence, treatment selection, factors associated with parathyroidectomy (PTX) vs the use of calcimimetics, and the use of dual-energy x-ray absorptiometry (DEXA) and parathyroid scintigraphy.
Methods
The study population consisted of 388 adult kidney transplant recipients seen during a one-year period at a single transplant center. Patients were classified as having either normal parathyroid parameters, secondary HPT, or tertiary HPT, and for all analyses, a p-value of <0.05 was considered significant.
Results
The prevalence of secondary HPT was 36.2% and that of tertiary HPT was 30.8%. Those with HPT had higher rates of anemia and higher mean creatinine than those with normal parathyroid parameters. PTH was inversely related to calcium in secondary HPT (r=-0.4, p<0.01) but not in tertiary HPT (r=-0.2, p=0.07).
In patients with tertiary HPT, evaluation included sestamibi scan in 56.8% and bone density in 24%. Treatment included PTX in 24.2% and cinacalcet in 70.5%. Determinants of PTX included higher serum calcium (OR per mg/dL 5.4, 95% CI 1.9-15.8), higher PTH (OR per log increase 6.2, 95% CI 1.2-32.6), multiple kidney transplants (OR 2.8, 95% CI 1.1-7.0), and presence of polycystic kidney disease (PKD) (OR 6.4, 95% CI 1.7-24.7). Those on cinacalcet appeared to have causes for both renal and non-renal secondary HPT along with less severe calcium elevations.
Conclusion
The burden of post-transplant HPT is significant and associated with poorer graft function. Determinants of PTX in those with tertiary HPT included higher serum calcium and PTH prior to treatment, multiple kidney transplants, and presence of PKD. Cinacalcet use was associated with milder calcium elevation and the presence of risk factors for secondary HPT. Our findings highlight the need for more consistent guidelines for evaluation and treatment of post-transplant HPT and its complications. We also highlight the need for uniform guidance for utilization of sestamibi scans and DEXA.
Funding
- Other NIH Support