Safety and Efficacy of a 3-Year Therapy With Cinacalcet in Persistent Hyperparathyroidism After Renal Transplant.

Transplant Proc

Renal Transplant Research Laboratory (LINT), School of Medical Sciences, University of Campinas, Campinas, SP, Brazil; Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.

Published: June 2020

Background: Persistent post-transplant hyperparathyroidism (PPTHP) can occur in 20% to 50% of renal transplant recipients. The aim of this study was to analyze safety and efficacy of long-term cinacalcet therapy in a group of renal transplant recipients with PPTHP.

Methods: A single center retrospective cohort study including renal transplant recipients, adults (>18 years old) with PPTHP and hypercalcemia. Inclusion criteria for cinacalcet therapy was increased parathormone levels (PTH > 65 pg/mL) associated with serum calcium >11.5 mg/dL any time after transplant or calcium >10.2 mg/dL within the first year after transplant. The follow-up period was 3 years. Demographic, laboratory data and adverse events were assessed.

Results: Forty-six patients were included, mean age of 50 ± 11 years old, majority of white race (60%), male (58%), with a pretransplant length on dialysis of 67 ± 34 months. Cinacalcet therapy was started 37 ± 40 months after transplant, and normal calcium levels were achieved after 6 months of therapy. PTH levels presented a steady reduction over time, reaching levels near normal after 36 months (317 ± 242 vs 145 ± 72 pg/mL, baseline × month 36, P < .05). Renal function remained stable over time (GFR > 60 mL/min/1.73 m) and no acute rejection episodes were observed. Most common adverse events were mild gastrointestinal symptoms. In 6 patients (12.5%) treatment was interrupted due to adverse events. Only 1 case (2%) was classified as treatment failure.

Conclusion: Cinacalcet therapy proved to be efficient for PPTHP and safe for graft and patient. Long-term treatment reduced PTH levels to near normal range.

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http://dx.doi.org/10.1016/j.transproceed.2020.02.024DOI Listing

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