Calcium Level-Dependence of the Adverse Effect of Tertiary Hyperparathyroidism on Graft Survival in Renal Transplant Recipients

M. Okada, T. Tomosugi, T. Hiramitsu, K. Futamura, A. Kanda, N. Goto, S. Narumi, T. Ichimori, Y. Watarai

Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan

Meeting: 2020 American Transplant Congress

Abstract number: B-044

Keywords: Graft survival, Hyperparathyroidism, Kidney transplantation, Multivariate analysis

Session Information

Session Name: Poster Session B: Kidney: Cardiovascular and Metabolic Complications

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Tertiary hyperparathyroidism (THPT) is a condition in which hyperparathyroidism persists after renal transplantation (RTx), and is a frequent complication. The aim of this retrospective cohort study is to clarify whether the adverse effect of THPT on the renal graft survival depends on serum calcium levels.

*Methods: Among 863 consecutive RTx, 422 didn’t have THPT (nHPT group), 392 have normocalcemic THPT (NC-HPT group) and 49 have hypercalcemic (serum calcium levels > 10.6mg/dL) THPT (HC-HPT group) after 6 months from successful RTx. Graft survival was compared among the groups, and cox proportional hazard regression analysis was conducted for graft survival.

*Results: Overall graft survival in HC-HPT was significantly lower among the three study groups (91.7% vs 86.1% vs 76.9% in the nHPT, NC-HPT and HC-HPT groups at ten years after RTx, P = 0.04). Cox hazard analysis revealed that hypercalcemic THPT was an independent risk factor for graft loss (P=0.04, hazard ratio 2.25; 95% confidence interval 1.02-4.99), however the association between normocalcemic THPT and graft loss wasn’t shown to be statistically significant (P=0.13, hazard ratio 1.45; 95% confidence interval 0.90-2.33).

*Conclusions: Hypercalcemic THPT should be treated aggressively because of its adverse effect for long-term graft survival in RTx.

Cox proportional hazard regression for graft loss
Factor	Hazard ratio	95% confidence interval	P value
Hypercalcemic THPT	2.25	1.02-4.99	0.045
Normocalcemic THPT	1.45	0.90-2.33	0.130
Male recipient	1.70	0.99-2.90	0.052
Recipient age	1.01	0.99-1.03	0.300
Diabetes	2.63	1.61-4.32	0.000
HLA incompatible RTx	3.14	1.39-7.09	0.006
Dialysis duration (month)	1.00	1.00-1.00	0.690

To cite this abstract in AMA style:

Okada M, Tomosugi T, Hiramitsu T, Futamura K, Kanda A, Goto N, Narumi S, Ichimori T, Watarai Y. Calcium Level-Dependence of the Adverse Effect of Tertiary Hyperparathyroidism on Graft Survival in Renal Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/calcium-level-dependence-of-the-adverse-effect-of-tertiary-hyperparathyroidism-on-graft-survival-in-renal-transplant-recipients/. Accessed May 16, 2025.

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