Pre-transplant low paratyroid hormone level: A risk factor for post-transplant osteoporosis and arterial stiffness

Abstract

Objectives:

Arterial stiffness is an early marker of arterial calcification. Adynamic bone disease is associated with microinflammation. The aim of this study is to evaluate the relationship between pre-transplant bone activity and post-transplant osteoporosis and arterial stiffness in kidney transplant recipients.

Methods:

One hundred and fifty kidney transplant recipients were enrolled into our study. All patients’ pre and post-transplant PTH levels, post-transplant lumbar t-scores and pulse wave velocity (PWv) were cross sectionally analyzed. Patients were divided into two groups according to pre-transplant PTH levels; patients with low PTH group (group 1; PTH<00 pg/ml, n: 91) and patients with normal or high PTH group (group 2; PTH>100 pg/ml, n: 59).

Results:

Serum PTH levels were slightly increased or stable after transplantation in group 1. In group 2; serum PTH levels was significantly decreased in 76 % of patients; however 24 % of group 2 patients had increased PTH after transplantation. In both groups, an increase in post-transplant PTH >30% was associated with higher serum creatinine and lower GFR levels and higher PWv. The factors influencing lumbar t-score were pre-transplant PTH, age and duration of hemodialysis. Pre-transplant PTH levels, lumbar t-score, age and duration after transplantation were detected as major determinants of PWv.

Conclusions:

Pre-transplant low serum PTH level is an important predictor for post-transplant osteoporosis and arterial stiffness. An increase in post-transplant PTH is associated with graft dysfunction and vascular stiffness that point out the importance of close follow-up and improve the PTH levels after renal transplantation.