Management of Persistent Hyperparathyroidism after Renal Transplantation.

Objective: Even after successful kidney transplantation, persistent hyperparathyroidism (HPT) with hypercalcemia is common, which is considered to be a risk factor for progressive bone loss, fractures, tubulointerstitial calcifications, vascular calcification, and development of graft dysfunction. The subtotal parathyroidectomy (PTX) is the standard treatment, but currently, it has been replaced by the calcimimetic cinacalcet. The aim of this single-center, retrospective study was to compare the long-term effects of PTX and cinacalcet on calcium, phosphorus, and parathyroid hormone (PTH) levels, as well as graft function in renal transplantation patients. Methods: The study population consisted of 24 patients followed between January 2004 and December 2020, 13 of whom underwent PTX and 12 of whom take cinacalcet therapy. The surgical group and the medical treatment group were compared. A control group with similar characteristics in terms of age, gender, transplant time, and kidney donor was formed, and the results were also compared with this group. The median PTH, calcium, phosphorus, creatinine levels, and eGFR values were recorded before/after PTX and cinacalcet therapy. Results: There was nonnegative effect of both PTX and cinacalcet groups on long-term and short-term allograft functions compared with control groups. Allograft functions were similar in comparison between PTX and cinacalcet groups. Conclusion: In conclusion, both cinacalcet treatment and PTX were found to be similarly effective and safe in reducing intact PTH and normalizing serum calcium in renal allograft recipients with hypercalcemia due to persistent HPT. [ABSTRACT FROM AUTHOR]