Dr JOCELYN SHAN1, Dr CATHRYN YOUINGS1, A/Prof DAVID J GOODMAN1,2, Prof FRANCESCO IERINO1,2
1St Vincent’s Hospital, Melbourne, Australia, 2University of Melbourne, , Australia
Aim
We aimed to study (1) post-transplant hypercalcemia with modern day immunosuppression, and (2) whether the impact of post-transplant parathyroidectomy on graft function has changed.
Background
While post-kidney transplant hypercalcemia and parathyroidectomy associated graft dysfunction are both described in literature, much of this is based on old data.
Methods
The study was a retrospective analysis of 262 patients managed at our center who received a renal transplant over a ten-year period, from 2010 to 2020. Of these, 201 were included with sufficient availability of medical records and diagnostic results.
Results
21 patients (10.4%) had persisting hypercalcemia at six months post-transplant, and 13 (6.5%) at 12 months. The mean (SD) serum corrected calcium was 2.7 (+/-0.103) mmol/L. Four patients were trialed on cinacalcet prior to operative management.
11 patients (5%) underwent parathyroidectomy, at a mean (SD) of 23 (+/-11) months post-transplant. The most common indications were persistent hypercalcemia, usually in the setting of parathyroid adenoma or hyperplasia, and nephrocalcinosis.
Seven patients (64%) had decreased graft function post-parathyroidectomy; one with transient post-operative acute kidney injury, and six (55%) with permanent decrease in eGFR. All seven had stable graft function pre-operatively and had no other cause of graft dysfunction identified post procedure other than parathyroidectomy.
Conclusions
Our findings suggest that the incidence of post-transplant hypercalcemia is less in the modern-day era, compared with previous reports of 16.6% at 12 months, but that permanent graft dysfunction following parathyroidectomy remains significant. Graft dysfunction, both transient and permanent needs to be fully discussed with the risks vs benefits of parathyroidectomy. Ongoing research is required to identify risk factors for graft dysfunction post-parathyroidectomy, and mechanisms for this phenomenon.
Biography:
Dr. Jocelyn Shan is a current General Medicine Advanced Trainee at St Vincent’s Hospital Melbourne, who will be commencing Nephrology Advanced Training next year. She intends to dual train, and particularly has a special interest in transplant medicine and renal bone disease.