Management of hypercalcemic hyperparathyroidism after renal transplantation
P. J. Garvin, M. Castaneda, R. Linderer and M. Dickhans
To determine the optimal management of posttransplant hypercalcemia, a
chart analysis of 100 stable renal allograft recipients (longer than one
year) was accomplished. The incidence of hypercalcemia ranged from 12% to
20% up to 30 months after transplantation. The mean serum alkaline
phosphatase level, phosphate level, and duration of dialysis in
hypercalcemic patients did not differ significantly from normocalcemic
patients; however, serum creatinine levels were significantly lower at 12
and 24 months in patients with hypercalcemia. In patients with
hypercalcemia at three and six months, greater than 50% underwent
spontaneous resolution, whereas this occurred in 25% of the patients with
hypercalcemia at 12 months. Seven patients underwent parathyroidectomy with
prompt resolution of their hypercalcemia and ten patients with persistent
hypercalcemia have been followed up from 14 to 66 months without sequelae
of hyperparathyroidism. In conclusion, hypercalcemic hyperparathyroidism is
a frequent occurrence after renal transplantation. Sequelae of this
condition are rare, however, and parathyroidectomy should be reserved for
progressive clinical and/or roentgenographic findings.
