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Impact of hyperparathyroidism on allograft histology and function after kidney transplantation: Rethinking its causal role in graft dysfunction

Cojuc-Konigsberg, Gabriel ; Tinajero-Sánchez, Denisse ; Canaviri-Flores, Vianca Anabel ; Fueyo-Rodríguez, Omar ; Uribe-Uribe, Norma O ; Marino-Vazquez, Lluvia A ; Morales-Buenrostro, Luis Eduardo ; Ramirez-Sandoval, Juan C

Clinical transplantation, 2024-05, Vol.38 (5), p.e15322-e15322 [Periódico revisado por pares]

Denmark

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Título:
Impact of hyperparathyroidism on allograft histology and function after kidney transplantation: Rethinking its causal role in graft dysfunction
Autor: Cojuc-Konigsberg, Gabriel ; Tinajero-Sánchez, Denisse ; Canaviri-Flores, Vianca Anabel ; Fueyo-Rodríguez, Omar ; Uribe-Uribe, Norma O ; Marino-Vazquez, Lluvia A ; Morales-Buenrostro, Luis Eduardo ; Ramirez-Sandoval, Juan C
Assuntos: Adult ; Allografts - pathology ; Female ; Follow-Up Studies ; Glomerular Filtration Rate ; Graft Rejection - etiology ; Graft Rejection - pathology ; Graft Survival ; Humans ; Hyperparathyroidism - etiology ; Hyperparathyroidism - pathology ; Kidney Failure, Chronic - surgery ; Kidney Function Tests ; Kidney Transplantation - adverse effects ; Male ; Middle Aged ; Parathyroid Hormone - blood ; Postoperative Complications - etiology ; Prognosis ; Retrospective Studies ; Risk Factors
É parte de: Clinical transplantation, 2024-05, Vol.38 (5), p.e15322-e15322
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: The causal relationship between hyperparathyroidism and kidney graft dysfunction remains inconclusive. Applying Bradford-Hill'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-zero graft biopsies. Retrospective cohort study evaluating the effect of hyperparathyroidism on interstitial fibrosis and tubular atrophy (IF/TA) development in 1232 graft biopsies. Pre-transplant hyperparathyroidism was categorized by KDIGO or KDOQI criteria, and post-transplant hyperparathyroidism by iPTH >1× and >2× the URL 1 year after transplantation. We included 325 KTRs (56% female, age 38 ± 13 years, follow-up 4.2 years [IQR: 2.7-5.8]). Based on pre-transplant iPTH levels, 26% and 66% exceeded the KDIGO and KDOQI targets, respectively. There were no significant differences in the development of >25% IF/TA between KTRs with pre-transplant iPTH levels above and within target range according to KDIGO (53% vs. 62%, P = .16, HR.94 [95% CI:.67-1.32]) and KDOQI (60% vs. 60%, P = 1.0, HR 1.19 [95% CI:.88-1.60]) criteria. Similarly, there were no differences when using 1 year post-transplant iPTH cut-offs > 88 pg/mL (58% vs. 64%, P = .33) and > 176 pg/mL (55% vs. 62%, P = .19). After adjusting for confounders, no significant differences were observed in eGFR trajectories among the iPTH strata. In young KTRs who received a healthy graft, no association was found between increased pre- and post-transplant 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.
Editor: Denmark
Idioma: Inglês

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Impact of hyperparathyroidism on allograft histology and function after kidney transplantation: Rethinking its causal role in graft dysfunction

Cojuc-Konigsberg, Gabriel ; Tinajero-Sánchez, Denisse ; Canaviri-Flores, Vianca Anabel ; Fueyo-Rodríguez, Omar ; Uribe-Uribe, Norma O ; Marino-Vazquez, Lluvia A ; Morales-Buenrostro, Luis Eduardo ; Ramirez-Sandoval, Juan C

Denmark

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