{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:39:43Z","timestamp":1792226383808,"version":"4.4.0"},"reference-count":37,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T00:00:00Z","timestamp":1719360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Hyperparathyroidism (HPT) with hypercalcemia, often deemed irreversible and detrimental to graft survival post-kidney transplantation (KT), prompts pre-transplant parathyroidectomy in hypercalcemic patients. In this retrospective analysis of 1212 kidney transplant recipients (KTRs) between 2006 and 2019, the incidence and effect of persistent HPT and hypercalcemia on graft and patient survival, and risk factors for persistence were analyzed until 60 months of follow up (FU). At KT, 5.7% (n = 69) had no HPT, 32.7% (n = 396) had HPT without hypercalcemia and 37.0% (n = 448) had HPT with hypercalcemia. At 2 years FU, 26.4% (n = 320) of patients had no HPT and 6% (n = 73) had HPT with hypercalcemia. Dialysis and dialysis duration were linked to HPT development, while dialysis, KT waiting time and donor type correlated with persisting hypercalcemia after KT. KTRs with normalized PTH and recovered hypercalcemia had improved death-censored graft survival (p &lt; 0.001) and overall patient survival (p &lt; 0.001). HPT with hypercalcemia is frequent at time of KT with normalization of PTH and calcium in a substantial proportion of patients after a KT. These findings question the routine pre-KT parathyroidectomy for suspected parathyroid autonomy. Persisting HPT, especially with hypercalcemia, adversely affects graft and patient survival, suggesting the need for more aggressive treatment of HPT, especially in cases of persisting hypercalcemia.<\/jats:p>","DOI":"10.3390\/diagnostics14131358","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T11:09:09Z","timestamp":1719400149000},"page":"1358","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Persisting Hypercalcemia and Hyperparathyroidism after Kidney Transplantation Have a Negative Impact on Graft and Patient Survival"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2079-4307","authenticated-orcid":false,"given":"Hannes","family":"Egli","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Burla","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7813-5149","authenticated-orcid":false,"given":"Eva","family":"Breuer","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Baron","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"H\u00fcbel","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"de Rougemont","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Seeger","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Vetter","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplant Surgery, University Hospital Zurich, 8032 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"ref_1","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group (2009). KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 76, S1\u2013S130."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.endonu.2015.05.006","article-title":"Prevalence of secondary hyperparathyroidism in patients with stage 3 and 4 chronic kidney disease seen in internal medicine","volume":"62","author":"Bureo","year":"2015","journal-title":"Endocrinol. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/sj.ki.5002009","article-title":"Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: Results of the study to evaluate early kidney disease","volume":"71","author":"Levin","year":"2007","journal-title":"Kidney Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"18","DOI":"10.4158\/EP.14.1.18","article-title":"Management of secondary hyperparathyroidism in stages 3 and 4 chronic kidney disease","volume":"14","author":"Andress","year":"2008","journal-title":"Endocr. Pract."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"V2","DOI":"10.1093\/ndt\/gfh1049","article-title":"The clinical consequences of secondary hyperparathyroidism: Focus on clinical outcomes","volume":"19","author":"Horl","year":"2004","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1097\/01.hjr.0000114706.27531.01","article-title":"Serum parathyroid hormone levels predict coronary heart disease: The Troms\u00f8 Study","volume":"11","author":"Kamycheva","year":"2004","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1681\/ASN.V12102131","article-title":"Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients","volume":"12","author":"Ganesh","year":"2001","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2762","DOI":"10.1097\/01.ASN.0000034202.91413.EB","article-title":"The severity of secondary hyperparathyroidism in chronic renal insufficiency is GFR-dependent, race-dependent, and associated with cardiovascular disease","volume":"13","author":"Gorodetskaya","year":"2002","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1038\/ki.2015.72","article-title":"Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism","volume":"88","author":"Komaba","year":"2015","journal-title":"Kidney Int."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1097\/01.ASN.0000133041.27682.A2","article-title":"Mineral metabolism, mortality, and morbidity in maintenance hemodialysis","volume":"15","author":"Block","year":"2004","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"913","DOI":"10.2215\/CJN.06040710","article-title":"Secondary hyperparathyroidism: Pathogenesis, disease progression, and therapeutic options","volume":"6","author":"Cunningham","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/SLA.0000000000001431","article-title":"How Well Does Renal Transplantation Cure Hyperparathyroidism?","volume":"262","author":"Lou","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1034\/j.1399-0012.2003.00047.x","article-title":"Hyperparathyroidism and long-term bone loss after renal transplantation","volume":"17","author":"Heaf","year":"2003","journal-title":"Clin. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1111\/ajt.12425","article-title":"Persistent hyperparathyroidism is a major risk factor for fractures in the five years after kidney transplantation","volume":"13","author":"Perrin","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/TP.0000000000000583","article-title":"Increased risk of all-cause mortality and renal graft loss in stable renal transplant recipients with hyperparathyroidism","volume":"99","author":"Pihlstrom","year":"2015","journal-title":"Transplantation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.surg.2017.10.016","article-title":"Timing of parathyroidectomy in kidney transplant candidates with secondary hyperparathryroidism: Effect of pretransplant versus early or late post-transplant parathyroidectomy","volume":"163","author":"Littbarski","year":"2018","journal-title":"Surgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1007\/s00268-008-9495-y","article-title":"Increase in bone mineral density after successful parathyroidectomy for tertiary hyperparathyroidism after renal transplantation","volume":"32","author":"Collaud","year":"2008","journal-title":"World J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1067\/msy.2000.108117","article-title":"A prospective surgical outcome study assessing the impact of parathyroidectomy on symptoms in patients with secondary and tertiary hyperparathyroidism","volume":"128","author":"Pasieka","year":"2000","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.cca.2020.01.033","article-title":"Comparison of estimated glomerular filtration rates in Chinese patients with chronic kidney disease among serum creatinine-, cystatin-C- and creatinine-cystatin-C-based equations: A retrospective cross-sectional study","volume":"505","author":"Hu","year":"2020","journal-title":"Clin. Chim. Acta"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1111\/ctr.12463","article-title":"Influence of recipient age on deceased donor kidney transplant outcomes in the expanded criteria donor era","volume":"28","author":"Farooq","year":"2014","journal-title":"Clin. Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/ctr.12291","article-title":"Hypercalcemia in renal transplant patients: Prevalence and management in Canadian transplant practice","volume":"28","author":"Muirhead","year":"2014","journal-title":"Clin. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1093\/oxfordjournals.ndt.a027843","article-title":"Sequential changes of biochemical bone parameters after kidney transplantation","volume":"13","author":"Reinhardt","year":"1998","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.2215\/CJN.02460310","article-title":"Measuring total blood calcium displays a low sensitivity for the diagnosis of hypercalcemia in incident renal transplant recipients","volume":"5","author":"Evenepoel","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1056\/NEJM197308232890804","article-title":"Hypercalcemia after renal transplantation. Long-term follow-up data","volume":"289","author":"David","year":"1973","journal-title":"N. Engl. J. Med."},{"key":"ref_26","first-page":"67","article-title":"Calcium metabolism and hyperparathyroidism after renal transplantation","volume":"52","author":"Cundy","year":"1983","journal-title":"Q. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1111\/j.1600-6143.2006.01475.x","article-title":"Early and severe hyperparathyroidism associated with hypercalcemia after renal transplant treated with cinacalcet","volume":"6","author":"Leca","year":"2006","journal-title":"Am. J. Transplant."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/j.1399-0012.2007.00690.x","article-title":"Elevated calcium phosphate product after renal transplantation is a risk factor for graft failure","volume":"21","author":"Egbuna","year":"2007","journal-title":"Clin. Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/j.transproceed.2007.03.025","article-title":"Calcium and phosphorus metabolism disturbances after renal transplantation","volume":"39","author":"Ramezani","year":"2007","journal-title":"Transplant. Proc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"665","DOI":"10.2215\/CJN.03920808","article-title":"Calcium metabolism in the early posttransplantation period","volume":"4","author":"Evenepoel","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.1681\/ASN.2018101030","article-title":"The Terrible Toll of the Kidney Shortage","volume":"29","author":"McCormick","year":"2018","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/ajt.15280","article-title":"OPTN\/SRTR 2017 Annual Data Report: Deceased Organ Donation","volume":"19","author":"Israni","year":"2019","journal-title":"Am J Transplant"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1177\/0391560321993540","article-title":"Living versus deceased kidney transplantation: Comparison of complications","volume":"88","author":"Namdari","year":"2021","journal-title":"Urologia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/ckj\/sfv145","article-title":"Calcifying circulating cells: An uncharted area in the setting of vascular calcification in CKD patients","volume":"9","author":"Cianciolo","year":"2016","journal-title":"Clin. Kidney J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e14085","DOI":"10.1111\/ctr.14085","article-title":"Early persistent hyperparathyroidism post-renal transplantation as a predictor of worse graft function and mortality after transplantation","volume":"34","author":"Isakov","year":"2020","journal-title":"Clin. Transplant."},{"key":"ref_36","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":"ref_37","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1007\/s00268-019-05124-6","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":"44","author":"Okada","year":"2020","journal-title":"World J. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/13\/1358\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:05:05Z","timestamp":1760108705000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/13\/1358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,26]]},"references-count":37,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["diagnostics14131358"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14131358","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,26]]}}}