Evaluating Hyperparathyroidism in Simultaneous Pancreas-Kidney Transplant Recipients: A Single-Center Experience.

INTRODUCTION

Cardiovascular disease remains the primary cause of mortality after kidney transplantation. Hyperparathyroidism (HPT) may contribute to the accelerated progression of coronary artery disease (CAD) and peripheral artery disease (PAD), particularly in transplant patients. This is particularly true when HPT overlaps with both renal failure and diabetes. Scant data exist to support medical or surgical management of tertiary hyperparathyroidism (3HPT) in simultaneous pancreas-kidney (SPK) transplant recipients. This study evaluates the outcomes of cardiovascular disease, bone health, and kidney and pancreas graft function as they relate to HPT in SPK recipients.

METHODS

Patients who received SPK transplantation at a large academic center were reviewed. Patient demographics, transplant specifics, evidence of HPT, graft survival, and mortality were collected. Patients were categorized as either resolved HPT or unresolved HPT (developed 3HPT). Independent group t-tests and Fisher's exact tests were used for bivariate comparisons.

RESULTS

Over 7 years, 132 patients received SPK transplantation. 41.7% of patients resolved HPT, and 58.3% of patients developed 3HPT. Those with 3HPT had significantly lower eGFR at 3 years (51.16 ± 21.58 vs. 62.55 ± 19.56 mL/min/1.73m2, p = 0.009) and higher HbA1c (6.05 ± 1.56 vs. 5.61 ± 0.83, p = 0.047). All patients experienced worsening radiographic evidence of large vessel calcifications (p < 0.001).

CONCLUSIONS

3HPT after SPK transplant is associated with worse function of both the renal and pancreatic grafts and peripheral arterial disease compared to those without 3HPT. A larger prospective cohort study is needed to determine causal relationships and develop treatment guidelines.