*Purpose: Pre-kidney transplant (KT) cinacalcet use is a predictor of persistent post-transplant hyperparathyroidism (HPT), often necessitating post-KT parathyroidectomy (PTX) or cinacalcet reinitiation, both of which have significant disadvantages. The purpose of this study was to compare post-transplant outcomes associated with pre-KT daily cinacalcet use of <30mg vs. >30mg.

*Methods: We conducted a retrospective cohort study of adult (> 18 years) KT patients from 1/1/2012-12/31/2016 prescribed cinacalcet pre-KT. Death at last follow-up and multi-organ transplants were excluded. Post-transplant PTX, cinacalcet reinitiation, and complications were compared based on pre-KT daily cinacalcet dose. Differences across compared groups for continuous variables were assessed using the independent sample t-test and for binary variables using the chi-square test. All p-values were 2-sided and <0.05 was considered to be statistically significant.

*Results: Of the 928 kidney transplant performed, 227 patients (111 in ≤30mg daily vs. 116 in >30mg daily group) met inclusion. Reinitiation of cinacalcet occurred in 69% of the >30mg group vs 41% of the ≤30mg group (p<0.001). The reinitaiton dose was significantly greater in the >30 mg daily cinacalcet group (p<0.001). Pre-KT daily cinacalcet use >30mg resulted in post-KT PTX at more than double the rate of patients with ≤30mg daily pre-KT use (p=0.021). Post-KT bone complications were also significantly greater in the >30mg daily group (p=0.040).

*Conclusions: Pre-KT daily cinacalcet doses >30mg was associated with post-KT cinacalcet reinitiation, PTX, and the development of bone disease. These results should be considered when evaluating KT candidates maintained on higher pre-KT cinacalcet doses to evaluate need for pre-KT PTX.

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