{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:52:21Z","timestamp":1787503941394,"version":"build-2736575974"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hyperparathyroidism (HPT) and malignancy are the most common causes of hypercalcemia. Among kidney transplant (KT) recipients, hypercalcemia is mostly caused by tertiary HPT. Persistent tertiary HPT after KT is associated with allograft failure. Previous studies on managing tHPT were subjected to survivor treatment selection bias; as such, the impact of tertiary HPT treatment on allograft function remained unclear. We aim to assess the association between hypercalcemic tertiary HPT treatment and kidney allograft survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We identified 280 KT recipients (2015-2019) with elevated post-KT adjusted serum calcium and parathyroid hormone (PTH). KT recipients were characterized by treatment: cinacalcet, parathyroidectomy, or no treatment. Time-varying Cox regression with delayed entry at the time of first elevated post-KT calcium was conducted, and death-censored and all-cause allograft failure were compared by treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 280 recipients with tHPT, 49 underwent PTx, and 98 received cinacalcet. The median time from KT to first elevated calcium was 1 month (IQR: 0-4). The median time from first elevated calcium to receiving cinacalcet and parathyroidectomy was 0(IQR: 0-3) and 13(IQR: 8-23) months, respectively. KT recipients with no treatment had shorter dialysis vintage (P\u2005=\u2005.017) and lower PTH at KT (P\u2005=\u2005.002), later onset of hypercalcemia post-KT (P\u2005&amp;lt;\u2005.001). Treatment with PTx (adjusted hazard ratio (aHR)\u2005=\u20050.18, 95%CI 0.04-0.76, P\u2005=\u2005.02) or cinacalcet (aHR\u2005=\u20050.14, 95%CI 0.004-0.47, P\u2005=\u2005.002) was associated with lower risk of death-censored allograft failure. Moreover, receipt of PTx (aHR\u2005=\u20050.28, 95%CI 0.12-0.66, P\u2005&amp;lt;\u2005.001) or cinacalcet (aHR\u2005=\u20050.38, 95%CI 0.22-0.66, P\u2005&amp;lt;\u2005.001) was associated with lower risk of all-cause allograft failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates that treatment of hypercalcemic tertiary HPT post-KT is associated with improved allograft survival. Although these findings are not specific to hypercalcemia of malignancy, they do demonstrate the negative impact of hypercalcemic tertiary HPT on kidney function. Hypercalcemic HPT should be screened and aggressively treated post-KT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/oncolo\/oyad314","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T17:17:09Z","timestamp":1699895829000},"page":"e467-e474","source":"Crossref","is-referenced-by-count":17,"title":["Treatment of Hypercalcemic Hyperparathyroidism After Kidney Transplantation Is Associated With Improved Allograft Survival"],"prefix":"10.1093","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3790-7840","authenticated-orcid":false,"given":"Rongzhi","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhiannon D","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Griffin","family":"Price","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marshall","family":"Lewis","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica Liu","family":"McMullin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"MacLennan","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cozette","family":"Killian","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayme E","family":"Locke","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineeta","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4481-5549","authenticated-orcid":false,"given":"Andrea","family":"Gillis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenessa","family":"Lindeman","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Fazendin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Alabama at Birmingham Heersink School of Medicine , Birmingham, AL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"2024041017271668500_CIT0001","doi-asserted-by":"crossref","first-page":"e935821","DOI":"10.12659\/MSM.935821","article-title":"A review of current clinical concepts in the pathophysiology, etiology, diagnosis, and management of hypercalcemia","volume":"28","author":"Tonon","year":"2022","journal-title":"Med Sci Monit."},{"key":"2024041017271668500_CIT0002","first-page":"154","article-title":"Hypercalcemia with a parathyroid hormone level of \u226450 pg\/ml: is this primary hyperparathyroidism","volume-title":"Surgery.","author":"Wang","year":"2023"},{"key":"2024041017271668500_CIT0003","first-page":"770","article-title":"Diagnosis, pathophysiology and management of hypercalcemia in malignancy: a review of the literature","volume-title":"Horm Metab Res.","author":"Asonitis","year":"2019"},{"key":"2024041017271668500_CIT0004","first-page":"373","article-title":"Clinical practice Hypercalcemia associated with cancer","volume-title":"N Engl J Med.","author":"Stewart","year":"2005"},{"key":"2024041017271668500_CIT0005","first-page":"145","article-title":"Hyperparathyroidism","volume-title":"Lancet.","author":"Fraser","year":"2009"},{"key":"2024041017271668500_CIT0006","first-page":"959","article-title":"The American Association of Endocrine Surgeons Guidelines for definitive management of primary hyperparathyroidism","volume-title":"JAMA Surg","author":"Wilhelm","year":"2016"},{"key":"2024041017271668500_CIT0007","first-page":"639","article-title":"Less is more: parathyroidectomy and the association with postoperative hypocalcemia in dialysis patients","volume-title":"J Am Coll Surg.","author":"Wang","year":"2023"},{"key":"2024041017271668500_CIT0008","first-page":"319","article-title":"Making the cut: parathyroidectomy before or after kidney transplantation","volume-title":"World J Surg.","author":"Wang","year":"2022"},{"issue":"1","key":"2024041017271668500_CIT0009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.kisu.2017.04.001","article-title":"Kdigo 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)","volume":"7","author":"Kidney Disease: Improving Global Outcomes CKDMBDUWG","year":"2017","journal-title":"Kidney Int Suppl (2011)"},{"key":"2024041017271668500_CIT0010","first-page":"1730","article-title":"Parathyroidectomy after successful kidney transplantation: a single centre study","volume-title":"Nephrol Dial Transplant.","author":"Evenepoel","year":"2007"},{"key":"2024041017271668500_CIT0011","first-page":"366","article-title":"Resolution of secondary hyperparathyroidism after kidney transplantation and the effect on graft survival","volume-title":"Ann Surg.","author":"Wang","year":"2023"},{"key":"2024041017271668500_CIT0012","first-page":"e141","article-title":"The American Association of Endocrine Surgeons Guidelines for the definitive surgical management of secondary and tertiary renal hyperparathyroidism","volume-title":"Ann Surg.","author":"Dream","year":"2022"},{"key":"2024041017271668500_CIT0013","first-page":"191","article-title":"Recovery versus persistence of disordered mineral metabolism in kidney transplant recipients","volume-title":"Semin Nephrol.","author":"Evenepoel","year":"2013"},{"key":"2024041017271668500_CIT0014","first-page":"184","article-title":"A prospective cohort study of mineral metabolism after kidney transplantation","volume-title":"Transplantation.","author":"Wolf","year":"2016"},{"key":"2024041017271668500_CIT0015","first-page":"479","article-title":"Parathyroid hormone and clinical outcome in kidney transplant patients with optimal transplant function","volume-title":"Clin Transplant.","author":"Bleskestad","year":"2014"},{"key":"2024041017271668500_CIT0016","first-page":"351","article-title":"Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism","volume-title":"Transplantation.","author":"Pihlstr\u00f8m","year":"2015"},{"key":"2024041017271668500_CIT0017","first-page":"94","article-title":"Timing of parathyroidectomy for tertiary hyperparathyroidism with end-stage renal disease: a cost-effectiveness analysis","volume-title":"Surgery.","author":"McManus","year":"2021"},{"key":"2024041017271668500_CIT0018","first-page":"293","article-title":"Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism","volume-title":"Am J Surg.","author":"Montgomery","year":"2022"},{"key":"2024041017271668500_CIT0019","first-page":"918","article-title":"Is preoperative parathyroid localization necessary for tertiary hyperparathyroidism","volume-title":"Am J Surg.","author":"Wang","year":"2022"},{"key":"2024041017271668500_CIT0020","first-page":"203","article-title":"My surgical practice: radioguided parathyroid surgery, how and why we use it","volume-title":"Am J Surg.","author":"Ramonell","year":"2022"},{"key":"2024041017271668500_CIT0021","first-page":"681","article-title":"Mediastinal parathyroidectomy: utilization of a multidisciplinary, robotic-assisted transthoracic approach in challenging cases","volume-title":"Am J 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Res.","author":"Lee","year":"2004"},{"key":"2024041017271668500_CIT0026","first-page":"53","article-title":"Long-term renal graft outcome after parathyroidectomy - a retrospective single centre study","volume-title":"BMC Nephrol.","author":"Patecki","year":"2020"},{"key":"2024041017271668500_CIT0027","first-page":"1311","article-title":"The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism","volume-title":"Nephrol Dial Transplant.","author":"Kruse","year":"2005"},{"key":"2024041017271668500_CIT0028","first-page":"2489","article-title":"Impact of parathyroidectomy on kidney graft function in post-transplant tertiary hyperparathyroidism: a comparative study","volume-title":"Langenbecks Arch Surg.","author":"Frey","year":"2022"},{"key":"2024041017271668500_CIT0029","first-page":"1972","article-title":"Timing of parathyroidectomy does not influence renal function after kidney transplantation","volume-title":"World J Surg.","author":"van der Plas","year":"2019"},{"key":"2024041017271668500_CIT0030","first-page":"1041","article-title":"Cinacalcet for the treatment of hyperparathyroidism in kidney transplant recipients: a systematic review and meta-analysis","volume-title":"Transplantation.","author":"Cohen","year":"2012"},{"key":"2024041017271668500_CIT0031","first-page":"129","article-title":"Parathyroidectomy versus cinacalcet in the management of tertiary hyperparathyroidism: surgery improves renal transplant allograft survival","volume-title":"Surgery.","author":"Finnerty","year":"2019"},{"key":"2024041017271668500_CIT0032","first-page":"999","article-title":"Survivor treatment selection bias in observational studies: examples from the aids literature","volume-title":"Ann Intern Med.","author":"Glesby","year":"1996"},{"key":"2024041017271668500_CIT0033","first-page":"8","article-title":"Charlson comorbidity index: a critical review of clinimetric properties","volume-title":"Psychother Psychosom.","author":"Charlson","year":"2022"},{"key":"2024041017271668500_CIT0034","first-page":"536","article-title":"Endocrine surgery: Where are we today? A national survey of young endocrine surgeons","volume-title":"Surgery.","author":"Solorzano","year":"2010"},{"key":"2024041017271668500_CIT0035","first-page":"1287","article-title":"Global trends and challenges in deceased donor kidney allocation","volume-title":"Kidney Int.","author":"Wu","year":"2017"},{"key":"2024041017271668500_CIT0036","first-page":"653","article-title":"How well does renal transplantation cure hyperparathyroidism","volume-title":"Ann Surg.","author":"Lou","year":"2015"},{"issue":"5","key":"2024041017271668500_CIT0037","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.surg.2017.12.010","article-title":"Persistent hyperparathyroidism as a risk factor for long-term graft failure: the need to discuss indication for parathyroidectomy","volume":"163","author":"Araujo","year":"2018","journal-title":"Surgery."},{"key":"2024041017271668500_CIT0038","first-page":"81","article-title":"Hyperparathyroidism is an independent risk factor for allograft dysfunction in pediatric kidney transplantation","volume-title":"Kidney Int Rep","author":"Prytula","year":"2023"},{"key":"2024041017271668500_CIT0039","first-page":"138","article-title":"Hyperparathyroidism at 1 year after kidney transplantation is associated with graft loss","volume-title":"Surgery.","author":"Crepeau","year":"2022"},{"key":"2024041017271668500_CIT0040","first-page":"823","article-title":"Hypercalcemia is a risk factor for the progression of aortic calcification in kidney transplant recipients","volume-title":"Kidney Blood Press Res.","author":"Naganuma","year":"2019"},{"key":"2024041017271668500_CIT0041","first-page":"e0167929","article-title":"Phosphocalcic markers and calcification propensity for assessment of interstitial fibrosis and vascular lesions in kidney allograft recipients","volume-title":"PLoS One.","author":"Berchtold","year":"2016"},{"key":"2024041017271668500_CIT0042","first-page":"498","article-title":"Comparison of pre- and post-transplant parathyroidectomy in renal transplant recipients and the impact of parathyroidectomy timing on calcium metabolism and renal allograft function: a retrospective single-center analysis","volume-title":"World J Surg.","author":"Okada","year":"2020"},{"key":"2024041017271668500_CIT0043","first-page":"727","article-title":"Parathyroidectomy or cinacalcet: do we still not know the best option for graft function in kidney-transplanted patients? A meta-analysis","volume-title":"Surgery.","author":"Frey","year":"2021"},{"key":"2024041017271668500_CIT0044","first-page":"2545","article-title":"A randomized study evaluating cinacalcet to treat hypercalcemia in renal transplant recipients with persistent hyperparathyroidism","volume-title":"Am J Transplant.","author":"Evenepoel","year":"2014"},{"key":"2024041017271668500_CIT0045","first-page":"2487","article-title":"A randomized study comparing parathyroidectomy with cinacalcet for treating hypercalcemia in kidney allograft recipients with hyperparathyroidism","volume-title":"J Am Soc Nephrol.","author":"Cruzado","year":"2016"},{"key":"2024041017271668500_CIT0046","first-page":"184","article-title":"Cinacalcet versus parathyroidectomy in the treatment of secondary hyperparathyroidism post renal transplantation","volume-title":"Rom J Intern Med.","author":"Soliman","year":"2016"}],"container-title":["The Oncologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/29\/4\/e467\/57210379\/oyad314.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/oncolo\/article-pdf\/29\/4\/e467\/57210379\/oyad314.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T14:15:15Z","timestamp":1712758515000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/oncolo\/article\/29\/4\/e467\/7450396"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,11,24]]},"published-print":{"date-parts":[[2024,4,4]]}},"URL":"https:\/\/doi.org\/10.1093\/oncolo\/oyad314","relation":{},"ISSN":["1083-7159","1549-490X"],"issn-type":[{"value":"1083-7159","type":"print"},{"value":"1549-490X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4,1]]},"published":{"date-parts":[[2023,11,24]]}}}