Background: Deceased donor kidney transplantation in long-term dialysis patients in Japan has been increasing because of a severe lack of donors. Parathyroid glands of long-term dialysis patients often show qualitative morphological changes from diffuse hyperplasia to nodular hyperplasia. Only a few studies have reported the clinicopathological analysis of persistent hyperparathyroidism after kidney transplantation in long-term (>10 years) dialysis patients.

Methods: This study on consecutive deceased donor kidney transplantation performed from 2002 to 2010 measured biochemical parameters related to bone and mineral disorders and examined parathyroid tissues in parathyroidectomy cases. Thirty-four subjects (22 males; mean age, 53.8±7.9 years, dialysis period, 14.4±4.3 years) were enrolled.

Results: Multivariate analysis of potential predictors for the hypercalcemia group at 12 months after transplantation showed that pre-transplantation and early post-transplantation (3–6 months) calcium and parathyroid hormone levels were significant determinants. Pathological examination showed that a number of glands showed nodular hyperplasia and decreased density of calcium sensing receptors and vitamin D receptors, even in small glands weighing <100 mg. In long-term dialysis patients, hyperparathyroidism and hypercalcemia were more likely to develop at an early stage after transplantation and persist for a long period (>4 years), with nodular hyperplasia being found even in low-weight parathyroid glands.

Conclusions: Persistent hyperparathyroidism was considered to be caused by irreversible qualitative change of the parathyroid glands, even if the glands were small. Treatment is recommended before possible adverse effects on the transplanted kidney.Although the best treatment option is to perform a parathyroidectomy in the waiting period before transplantation, we suggest that it be performed in cases with prolonged hypercalcemia of >6 months after transplantation.

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