[The incidence of tertiary hyperparathyroidism after renal transplantation].

INTRODUCTION

Tertiary hyperparathyroidism (3 degrees HPT) is a condition characterized by autonomous secretion of parathyroid hormone (PTH) which develops as a consequence of secondary hyperparathyroidism in patients with chronic renal failure. Severe cases of 3 degrees HPT are treated with parathyroidectomy (Ptx). The purpose of this study was to uncover the incidence of 3 degrees HPT and frequency of Ptx after renal transplantation (Tx). Furthermore, we wanted to identify parameters that predicted the development of 3 degrees HPT and the prognosis.

MATERIALS AND

METHODS

The study included 189 consecutive patients who underwent Tx at Odense University Hospital from 1/1/2000 to 12/31/2004. We defined 3 degrees HPT as at least one elevated measurement of P-PTH concurrent with elevated S-Ca2+. Elevated S-Ca2+ was defined as at least 5 consecutive, elevated measurements from 14 days to six months after Tx.

RESULTS

A total of 59 patients (39%) developed 3 degrees HPT after Tx and 13 (22%) of these underwent Ptx. Diabetes mellitus type-1 (DM type-1) significantly increased the risk of 3 degrees HPT. The median duration from Tx to Ptx was 223 (33-911) days. In non-Ptx patients, the median duration of hypercalcemia due to 3 degrees HPT was 37 months.

CONCLUSION

3 degrees HPT occurred in approximately 1/3 of the patients and DM-type-1 increased the risk. Without Ptx regression of 3 degrees HPT was seen even after several years' duration.