• Philip K Crepeau, Yi Liu, Joy Z Done, Darci Foote, Daniel C Brennan, Lilah F Morris-Wiseman, Dorry L Segev, Mara McAdams-DeMarco, and Aarti Mathur.
• From the Department of Surgery (Crepeau, Done, Foote, Morris-Wiseman, Mathur), Johns Hopkins University School of Medicine, Baltimore, MD.
• J. Am. Coll. Surg. 2024 Dec 1; 239 (6): 600608600-608.

BackgroundBefore kidney transplantation (KT), most patients have an elevated parathyroid hormone (PTH). However, the impact of PTH on post-KT mortality and graft loss is unclear. We quantified the association between PTH levels measured at transplantation and adverse post-KT outcomes.Study DesignWe leveraged a prospective longitudinal cohort of 1,136 KT recipients from a single tertiary care center between December 2008 and February 2020. Pre-KT PTH levels were abstracted retrospectively. Adjusted multivariable Cox proportional hazards models were used to estimate the association between pre-KT PTH levels and mortality and death-censored graft loss (DCGL).ResultsOf 1,136 recipients, pre-KT PTH levels were 300 pg/mL or less in 62.3% and more than 600 pg/mL in 12.5%. Compared with those with a pre-KT PTH 300 pg/mL or less, patients with a pre-KT PTH more than 600 pg/mL were more likely to be Black (51.4% vs 34.6%) and have a longer dialysis vintage (4.8 vs 1.7 years, p < 0.001). Those with a pre-KT PTH more than 600 pg/mL had a higher 10-year cumulative incidence of DCGL than those with PTH 300 pg/mL or less (31.7% vs 15.4%, p < 0.001). After adjusting for confounders, pre-KT PTH more than 600 pg/mL was associated with a 1.76-fold increased risk of DCGL (95% CI 1.16 to 2.65). The magnitude of this association differed by race (p interaction = 0.011) and by treatment (p interaction = 0.018). Among non-Black patients, a PTH more than 600 pg/mL was associated with a 3.21-fold increased risk of DCGL compared with those with PTH 300 pg/mL or less (95% CI 1.77 to 5.81). Among untreated patients, those with PTH more than 600 pg/mL had a 2.54-fold increase in DCGL (95% CI 1.44 to 4.47). No association between pre-KT PTH and mortality risk was observed.ConclusionsPTH more than 600 pg/mL before KT increased the risk of DCGL by 76%, demonstrating the importance of treating PTH before KT to prevent graft loss in a contemporary era with the introduction and widespread availability of medical therapy.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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