Successful renal transplantation improves chronic kidney disease-mineral and bone disorder in children, nevertheless several factors contribute to persistent bone disorder in transplant recipients such as immunosuppressive treatment, severe hyperparathyroidism and impaired graft function. Fibroblast growth factor 23 (FGF23) is a phosphaturic hormone associated with phosphate wasting and osteomalacia.
The aim of this study was to determine the FGF23 blood levels at transplant and after 12 months, and the prevalence of pre-transplant bone mineral disorder and its evolution post-transplant.
Pediatric transplant recipients <17 years were invited to participate. The IRB and the Ethics Committee approved the study. Serum levels of calcium, phosphorus, magnesium and creatinine were determined at transplant and plasma FGF23, intact parathyroid hormone (PTH), at transplant and 12 months.
Results: 32 patients were included, mean age 14.5 ± 3.5 years, male (53%), 18 patients were in peritoneal dialysis (56%), nine in hemodialysis (28%) and five patients received preemptive transplantation (16%). Immunosuppressive regimen included anti-CD25 induction, prednisone mophetil mycophenolate and tacrolimus. Mean glomerular filtration rate at 12 months post-transplant was 87 ±17 ml/min/1.73m2 by Schwartz formula. 58% had pre-transplant <150pg/mL, 42% > 300pg/mL, and only 12% PTH in recommended values. Nine patients (28%) had post-transplant hypophosphatemia and six patients hypomagnesemia. FGF23 values at transplant were 341 pg/mL (range 23 to 3864) and reduced significantly after 12 months post-transplant (median 60, range 2.5 to 2312 pg/mL). Patients with post-transplant hypophosphatemia had higher levels of FGF23 at transplant (1476 ± 514 pg/mL) vs. patients without hypophosphatemia (62 ± 12.9 pg/mL), p=0.02.
One third of pediatric patients develop post-transplant hypophosphatemia.
58% of patients had low PTH values pre-transplant.
FGF23 blood levels diminishes significantly after successful renal transplant.
FGF23 levels at transplant were significantly higher in patients with post-transplant hypophosphatemia.
To cite this abstract in AMA style:Medeiros M, Rico J, García-Roca P, Hernández A, Ortiz L, Aldana R, Díaz-Barriga D, Valverde S, Velásquez-Forero F. Serum Changes in FGF23 and Biochemical Biomarkers of Bone Mineral Disorder in Children after Renal Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/serum-changes-in-fgf23-and-biochemical-biomarkers-of-bone-mineral-disorder-in-children-after-renal-transplantation/. Accessed November 22, 2020.
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