title: Persistent secondary hyperparathyroidism after renal transplantation in children.
abstract: Secondary hyperparathyroidism (HPTH) is a frequent complication of chronic kidney disease (CKD). Renal transplantation corrects the biochemical abnormalities that cause HPTH; however, HPTH persists in some patients. The factors that contribute to the persistence of HPTH after transplantation in children are poorly understood. We examined 57 children who underwent renal transplantation and determined whether baseline clinical and biochemical parameters could predict the persistence of HPTH at 1 year post-transplantation, using multivariate logistic regression. At the time of transplantation, serum parathyroid hormone (PTH) levels were >300 pg/ml in 60%, 150-300 pg/ml in 17%, and <150 pg/ml in 23% of recipients. HPTH (PTH >73 pg/ml) persisted in 78% of patients at 6 months and in 56% at 1 year after transplant. Older age at transplantation was the strongest predictor of HPTH at 1 year (OR=1.17, P<0.05). After adjustment for age, other baseline clinical or laboratory parameters were not predictive of HPTH at 1 year. The relationship between older age and persistent HPTH may be explained by longer duration of CKD. Given the potential morbidities associated with persistent HPTH, the role of interventions that would prevent or reverse persistent HPTH post-transplantation requires further investigation.
authors.affiliation: Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, USA.
authors.forename: Mina
authors.initials: M
authors.lastname: Matsuda-Abedini
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Portale
authors.forename: Amol
authors.initials: A
authors.lastname: Shah
authors.forename: John
authors.initials: J
authors.lastname: Neuhaus
authors.forename: Marilyn
authors.initials: M
authors.lastname: McEnhill
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mathias
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007223:Infant; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood; D012086:Reoperation
chemical_list: D010281:Parathyroid Hormone