FGF23 is associated with early post-transplant hypophosphataemia and normalizes faster than iPTH in living donor renal transplant recipients: a longitudinal follow-up study.
BACKGROUND
We aimed to longitudinally analyse changes in the levels of serum fibroblast growth factor 23 (FGF23), intact parathyroid hormone (iPTH) and associated minerals in patients undergoing renal transplantation.


METHODS
Sixty-three patients with end-stage renal disease (ESRD) who underwent living donor transplantation were recruited. Serum FGF23, iPTH, uric acid, inorganic phosphorous (iP), blood urea nitrogen and serum creatinine were measured pre-transplant and at 1 (M1), 3 (M3) and 12 months (M12) post-transplantation.


RESULTS
FGF23 levels were decreased at M1, M3 and M12 by 93.81, 96.74 and 97.53%, respectively. iPTH levels were decreased by 67.95, 74.95 and 84.9%, respectively. The prevalence of hyperparathyroidism at M1, M3 and M12 post-transplantation was 63.5, 42.9 and 11.1%, respectively. FGF23 and iP levels remained above the normal range in 23 (36.5%) and 17 (27%) patients at M1, 10 (15.9%) and 5 (8%) at M3 and in none at M12 post-transplantation, respectively. A multivariate regression model revealed that, pre-transplant, iP was positively associated with iPTH (P = 0.016) but not with FGF 23; however, post-transplant, iP level was negatively associated with FGF23 (P < 0.001) but not with iPTH.


CONCLUSIONS
Post-transplant FGF23 levels settle faster than those of iPTH. However, 11% of patients continued to have hyperparathyroidism even after 12 months.
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Narayan
N
Prasad
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Akhilesh
A
Jaiswal
Clinical Immunology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Vikas
V
Agarwal
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Shashi
S
Kumar
Clinical Immunology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Saurabh
S
Chaturvedi
Endocrinology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Subhash
S
Yadav
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Amit
A
Gupta
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Raj K
RK
Sharma
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Dharmendra
D
Bhadauria
Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , Uttar Pradesh, India.
Anupama
A
Kaul
fibroblast growth factor 23; hyperparathyroidism; hypophosphataemia; intact parathyroid hormone; renal transplantation
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