Vitamin D and cinacalcet administration pre-transplantation predict hypercalcaemic hyperparathyroidism post-transplantation: a case-control study of 355 deceased-donor renal transplant recipients over 3?years

摘要

Background The effects of pre-transplantation medication for secondary hyperparathyroidism on post-transplantation parathyroid hormone (PTH) and calcium levels have not yet been conclusively determined. Therefore, this study sought to determine the level of off-label use of cinacalcet and to determine predictors of its administration during the long-term follow-up of a cohort of individuals who received deceased-donor renal transplants. Furthermore, safety considerations concerning the off-label use of cinacalcet are addressed. Methods This was a case-control study of 355 stable renal transplant recipients. The patient cohort was divided into two groups. Transplant group A comprised patients who did not receive cinacalcet treatment, and transplant group B comprised patients who received cinacalcet treatment during follow-up after renal transplantation. The characteristics of the patients were evaluated to determine predictors of cinacalcet use after successful renal transplantation. Results Compared with the control individuals (n?=?300), the cinacalcet-treated individuals (n?=?55) had significantly higher PTH levels at 4?weeks post-transplantation (20.3?±?1.6 versus 40.7?±?4.0 pmol/L, p?=?0.0000) when they were drug naive. At 3.2?years post-transplantation, cinacalcet-treated patients showed higher PTH (26.2?±?2.3 versus 18.4?±?2.3 pmol/L, p?=?0.0000), higher calcium (2.42?±?0.03 versus 2.33?±?0.01?mmol/L, p?=?0.0045) and lower phosphate (0.95?±?0.04 versus 1.06?±?0.17?mmol/L, p?=?0.0021) levels. Individuals in the verum group were more likely to receive cinacalcet therapy (45.5% versus 14.3%, p?=?0.0000), and they had higher pill burdens for the treatment of hyperparathyroidism (1.40?±?0.08 versus 0.72?±?0.03 pills per patient, p?=?0.0000) whilst they were on the waiting list for transplantation. Regression analysis confirmed the associations between hypercalcaemic hyperparathyroidism and PTH levels at 4?weeks post-transplantation (p?=?0.0001), cinacalcet use (p?=?0.0000) and the preoperative total pill burden (p?=?0.0000). Renal function was the same in both groups. Conclusions Parathyroid gland dysfunction pre-transplantation translates into clinically relevant hyperparathyroidism post-transplantation, despite patients being administered more intensive treatment whilst on dialysis. PTH levels at 4?weeks post-transplantation might serve as a marker for the occurrence of hypercalcaemic hyperparathyroidism during follow-up.