Park Peong Gang, Han Ahram, Ahn Yo Han, Min Sangil, Ha Jongwon, Kang Hee Gyung, Lee Hyun Kyung
Departments of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ren Fail. 2025 Dec;47(1):2511279. doi: 10.1080/0886022X.2025.2511279. Epub 2025 Jun 1.
Persistent hyperparathyroidism after kidney transplantation (KT) has been reported in up to 50% of adult recipients, but pediatric data remain limited. We evaluated the prevalence, skeletal manifestations, and risk factors for persistent hyperparathyroidism in children following KT.
In this retrospective cohort study, 107 pediatric KT recipients (58% male; median age 10.3 years) transplanted between 2004 and 2019 were analyzed. Persistent hyperparathyroidism was defined as a median parathyroid hormone (PTH) > 65 pg/mL between 3 and 12 months post-KT. Risk factors for persistent hyperparathyroidism, post KT clinical features, and treatment status were analyzed.
Thirty-six patients (33.6%) had persistent hyperparathyroidism after KT. On univariable analysis, dialysis duration of 24 months or longer ( = 0.028) and pretransplant hyperphosphatemia ( = 0.026) were significantly associated with persistent hyperparathyroidism. The multivariable model identified pretransplant hyperphosphatemia as an independent predictor (OR 2.70, 95% CI 1.10-6.87; = 0.030). There was no significant difference in height Z score change between patients with and without persistent hyperparathyroidism ( = 0.97). However, persistent hyperparathyroidism was associated with poorer graft survival (log-rank = 0.049). Six patients received cinacalcet and one underwent subtotal parathyroidectomy for refractory hypercalcemia.
Persistent hyperparathyroidism is relatively common in pediatric KT recipients, affecting one-third of patients by one-year post-transplant. Prolonged dialysis and pre-existing hyperphosphatemia before KT may be risk factors. These findings underscore the importance of optimizing chronic kidney disease-mineral bone disease management and routine PTH monitoring before and after transplant in children.
肾移植（KT）后持续性甲状旁腺功能亢进在高达50%的成年受者中已有报道，但儿科数据仍然有限。我们评估了儿童肾移植后持续性甲状旁腺功能亢进的患病率、骨骼表现及危险因素。
在这项回顾性队列研究中，分析了2004年至2019年间接受肾移植的107例儿科患者（58%为男性；中位年龄10.3岁）。持续性甲状旁腺功能亢进定义为肾移植后3至12个月甲状旁腺激素（PTH）中位数>65 pg/mL。分析了持续性甲状旁腺功能亢进的危险因素、肾移植后的临床特征及治疗情况。
36例患者（33.6%）肾移植后发生持续性甲状旁腺功能亢进。单因素分析显示，透析时间24个月或更长（P = 0.028）及移植前高磷血症（P = 0.026）与持续性甲状旁腺功能亢进显著相关。多变量模型确定移植前高磷血症为独立预测因素（OR 2.70，95%CI 1.10 - 6.87；P = 0.030）。有或无持续性甲状旁腺功能亢进的患者身高Z评分变化无显著差异（P = 0.97）。然而，持续性甲状旁腺功能亢进与移植肾存活率较低相关（对数秩检验P = 0.049）。6例患者接受了西那卡塞治疗，1例因难治性高钙血症接受了甲状旁腺次全切除术。
持续性甲状旁腺功能亢进在儿科肾移植受者中相对常见，移植后1年影响三分之一的患者。肾移植前透析时间延长和既往存在的高磷血症可能是危险因素。这些发现强调了优化儿童慢性肾脏病 - 矿物质和骨疾病管理以及移植前后常规监测PTH的重要性。
