{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:52:48Z","timestamp":1778806368725,"version":"3.51.4"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,28]],"date-time":"2024-04-28T00:00:00Z","timestamp":1714262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The causal relationship between hyperparathyroidism and kidney graft dysfunction remains inconclusive. Applying Bradford\u2010Hill's temporality and consistency causation principles, we assessed the effect of parathyroid hormone (iPTH) on graft histology and eGFR trajectory on kidney transplant recipients (KTRs) with normal time\u2010zero graft biopsies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study evaluating the effect of hyperparathyroidism on interstitial fibrosis and tubular atrophy (IF\/TA) development in 1232 graft biopsies. Pre\u2010transplant hyperparathyroidism was categorized by KDIGO or KDOQI criteria, and post\u2010transplant hyperparathyroidism by iPTH\u00a0&gt;1\u00d7 and\u00a0&gt;2\u00d7 the URL 1 year after transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 325 KTRs (56% female, age 38\u00a0\u00b1\u00a013 years, follow\u2010up 4.2 years [IQR: 2.7\u20105.8]). Based on pre\u2010transplant iPTH levels, 26% and 66% exceeded the KDIGO and KDOQI targets, respectively. There were no significant differences in the development of\u00a0&gt;25% IF\/TA between KTRs with pre\u2010transplant iPTH levels above and within target range according to KDIGO (53%\u00a0vs. 62%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.16, HR.94 [95% CI:.67\u20131.32]) and KDOQI (60%\u00a0vs. 60%, <jats:italic>P<\/jats:italic>\u00a0=\u00a01.0, HR 1.19 [95% CI:.88\u20131.60]) criteria. Similarly, there were no differences when using 1 year post\u2010transplant iPTH cut\u2010offs\u00a0&gt;\u00a088 pg\/mL (58%\u00a0vs. 64%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.33) and\u00a0&gt;\u00a0176 pg\/mL (55%\u00a0vs. 62%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.19). After adjusting for confounders, no significant differences were observed in eGFR trajectories among the iPTH strata.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In young KTRs who received a healthy graft, no association was found between increased pre\u2010 and post\u2010transplant iPTH levels and graft dysfunction, as assessed histologically and through eGFR trajectory. The concept of hyperparathyroidism as a risk factor for graft dysfunction in recipients at low risk requires reevaluation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15322","type":"journal-article","created":{"date-parts":[[2024,4,28]],"date-time":"2024-04-28T17:33:58Z","timestamp":1714325638000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of hyperparathyroidism on allograft histology and function after kidney transplantation: Rethinking its causal role in graft dysfunction"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3463-6309","authenticated-orcid":false,"given":"Gabriel","family":"Cojuc\u2010Konigsberg","sequence":"first","affiliation":[{"name":"Department of Nephrology and Mineral Metabolism Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubiran  Mexico City 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y Nutrici\u00f3n Salvador Zubiran  Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norma O.","family":"Uribe\u2010Uribe","sequence":"additional","affiliation":[{"name":"Department of Pathology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubiran  Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lluvia A.","family":"Marino\u2010Vazquez","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Mineral Metabolism Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubiran  Mexico City Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Eduardo","family":"Morales\u2010Buenrostro","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Mineral Metabolism Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubiran  Mexico City 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