*Purpose: Patients with chronic kidney disease or end stage kidney disease often have secondary hyperparathyroidism, which improves after kidney transplantation. However, persistent hyperparathyroidism requiring continued treatment with a calcimimetic agent or parathyroidectomy is common. We performed a retrospective cohort study to examine persistent hyperparathyroidism in our patients after renal transplant. We hypothesized that the intact parathyroid hormone (iPTH) level at time of transplant would predict subsequent parathyroidectomy or cinacalcet use.

*Methods: We reviewed records of all kidney transplant recipients between 1/1/2016 and 12/31/2016. Data collected included various demographic, clinical, and biochemical variables. Patients with persistent hyperparathyroidism and/ or who needed a calcimimetic (cinacalcet) or parathyroidectomy were compared with those who did not.

*Results: 184 patients were identified. Of these recipients, 39.9% were female, and 60% were black. Mean age was 50.0 (SD 11.6) years. Deceased donor organs were used in 63%; 82% had been on chronic dialysis, with a mean duration of 50.2 (SD 46.4) months. Pretransplant, 95.2% of patients had hyperparathyroidism, with a mean iPTH of 656.73 (SD 973.4) pg/ml. Before transplant, 6 (4.9%) patients had a parathyroidectomy, and 114 (61.9%) used cinacalcet. At 1 year posttransplant, parathyroidectomy occurred in 12 (6.5%) patients, and 37 (20%) remained on cinacalcet. Only 15.7% of patients had a 1-year iPTH result within the normal range (<88 pg/ml), mean iPTH was 220.1 (SD 167.1) pg/ml and mean 25-hydroxy vitamin D level was 29.19 (SD 12.6) ng/ml. Multi-variable logistic regression analysis identified the following as associated with cinacalcet use and/ or parathyroidectomy at 1 year post-transplant: pre-transplant cinacalcet use (OR 12.3 [95% CI: 3.78-39.79], p<0.0001), adjusted Ca at transplant (OR 3.47 [95% CI 1.71 - 7.97] p=0.001), and duration of dialysis (OR 1.02 [95%CI 1.01 - 1.03], p=0.008). iPTH level at transplant was not associated with cinacalcet use or parathyroidectomy at 1 year post-transplant.

*Conclusions: Persistent hyperparathyroidism requiring intervention was prevalent in our patient cohort. Surprisingly, the iPTH level at the time of transplant did not predict need for cinacalcet or parathyroidectomy at

1-year post-transplant.

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