Impact of hyperparathyroidism and its different subtypes on long term graft outcome: a single Transplant Center cohort study

Paolo Molinari; Anna Regalia; Alessandro Leoni; Mariarosaria Campise; Donata Cresseri; Elisa Cicero; Simone Vettoretti; Luca Nardelli; Emilietta Brigati; Evaldo Favi; Piergiorgio Messa; Giuseppe Castellano; Carlo M Alfieri

doi:10.3389/fmed.2023.1221086

Impact of hyperparathyroidism and its different subtypes on long term graft outcome: a single Transplant Center cohort study

Front Med (Lausanne). 2023 Aug 10:10:1221086. doi: 10.3389/fmed.2023.1221086. eCollection 2023.

Authors

Paolo Molinari^{1

2}, Anna Regalia¹, Alessandro Leoni¹, Mariarosaria Campise¹, Donata Cresseri¹, Elisa Cicero^{1

2}, Simone Vettoretti¹, Luca Nardelli¹, Emilietta Brigati¹, Evaldo Favi^{3

4}, Piergiorgio Messa⁵, Giuseppe Castellano^{1

3}, Carlo M Alfieri^{1

3}

Affiliations

¹ Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
² Post-Graduate School of Specialization in Nephrology, University of Milano, Milan, Italy.
³ Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
⁴ General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁵ Department of Nephrology, Dialysis and Kidney Transplants, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy.

Abstract

Purpose: We studied the association between parathormone (PTH) levels and long-term graft loss in RTx patients (RTx-p).

Methods: We retrospectively evaluated 871 RTx-p, transplanted in our unit from Jan-2004 to Dec-2020 assessing renal function and mineral metabolism parameters at 1, 6, and 12 months after RTx. Graft loss and death with functioning graft during follow-up (FU, 8.3[5.4-11.4] years) were checked.

Results: At month-1, 79% had HPT, of which 63% with secondary HPT (SHPT) and 16% tertiary HPT (THPT); at month-6, HPT prevalence was 80% of which SHPT 64% and THPT 16%; at month-12 HPT prevalence was 77% of which SHPT 62% and THPT 15%. A strong significant correlation was found between HPT type, PTH levels and graft loss at every time point. Mean PTH exposure remained strongly and independently associated to long term graft loss (OR 3.1 [1.4-7.1], p = 0.008). THPT was independently associated with graft loss at month-1 when compared to HPT absence and at every time point when compared to SHPT. No correlation was found with RTx-p death. Discriminatory analyses identified the best mean PTH cut-off to predict long-term graft loss to be between 88.6 and 89.9 pg/mL (AUC = 0.658). Cox regression analyses highlighted that THPT was strongly associated with shorter long-term graft survival at every time-point considered.

Conclusion: High PTH levels during 1st year of RTx seem to be associated with long term graft loss.

Keywords: graft outcome; hyperparathyroidism; kidney transplantation; parathormone; tertiary hyperparathyroidism.