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Prevalence and risk factors for tertiary hyperparathyroidism in kidney transplant recipients

Sutton, Whitney; Chen, Xiaomeng; Patel, Palak; Karzai, Shkala; Prescott, Jason D; Segev, Dorry L; McAdams-DeMarco, Mara; Mathur, Aarti
BACKGROUND:Tertiary hyperparathyroidism after kidney transplantation has been associated with graft dysfunction, cardiovascular morbidity, and osteopenia; however, its true prevalence is unclear. The objective of our study was to evaluate the prevalence of and risk factors for tertiary hyperparathyroidism. METHODS:A prospective cohort of 849 adult kidney transplantation recipients (December 2008-February 2020) was used to estimate the prevalence of hyperparathyroidism 1-year post-kidney transplant. Tertiary hyperparathyroidism was defined as hypercalcemia (≥10mg/dL) and hyperparathyroidism (parathyroid hormone≥70pg/mL) 1-year post-kidney transplantation. Modified Poisson regression models were used to evaluate risk factors associated with the development of both persistent hyperparathyroidism and tertiary hyperparathyroidism. RESULTS:Among kidney transplantation recipients, 524 (61.7%) had persistent hyperparathyroidism and 182 (21.5%) had tertiary hyperparathyroidism at 1-year post-kidney transplantation. Calcimimetic use before kidney transplantation was associated with 1.30-fold higher risk of persistent hyperparathyroidism (adjusted prevalence ratio = 1.30, 95% CI: 1.12-1.51) and 1.84-fold higher risk of tertiary hyperparathyroidism (adjusted prevalence ratio = 1.84, 95% CI: 1.25-2.72). Pre-kidney transplantation parathyroid hormone ≥300 pg/mL was associated with 1.49-fold higher risk of persistent hyperparathyroidism (adjusted prevalence ratio = 1.49, 95% CI = 1.19-1.85) and 2.21-fold higher risk of tertiary hyperparathyroidism (adjusted prevalence ratio = 2.21, 95% CI = 1.25-3.90). Pre-kidney transplantation tertiary hyperparathyroidism was associated with an increased risk of post-kidney transplantation tertiary hyperparathyroidism (adjusted prevalence ratio = 1.71, 95% CI = 1.29-2.27), but not persistent hyperparathyroidism. Furthermore, 73.0% of patients with persistent hyperparathyroidism and 61.5% with tertiary hyperparathyroidism did not receive any treatment at 1-year post-kidney transplantation. CONCLUSION/CONCLUSIONS:Persistent hyperparathyroidism affected 61.7% and tertiary hyperparathyroidism affected 21.5% of kidney transplantation recipients; however, the majority of patients were not treated. Pre-kidney transplantation parathyroid hormone levels ≥300pg/mL and the use of calcimimetics are associated with the development of tertiary hyperparathyroidism. These findings encourage the re-evaluation of recommended pre-kidney transplantation parathyroid hormone thresholds and reconsideration of pre-kidney transplantation secondary hyperparathyroidism treatments to avoid the adverse sequelae of tertiary hyperparathyroidism in kidney transplantation recipients.
PMCID:8688275
PMID: 34266650
ISSN: 1532-7361
CID: 5127432

Cognitive Impairment and Physical Frailty in Patients With Cirrhosis

Berry, Kacey; Duarte-Rojo, Andres; Grab, Joshua D; Dunn, Michael A; Boyarsky, Brian J; Verna, Elizabeth C; Kappus, Matthew R; Volk, Michael L; McAdams-DeMarco, Mara; Segev, Dorry L; Ganger, Daniel R; Ladner, Daniela P; Shui, Amy; Tincopa, Monica A; Rahimi, Robert S; Lai, Jennifer C
Physical frailty and impaired cognition are common in patients with cirrhosis. Physical frailty can be assessed using performance-based tests, but the extent to which impaired cognition may impact performance is not well characterized. We assessed the relationship between impaired cognition and physical frailty in patients with cirrhosis. We enrolled 1,623 ambulatory adult patients with cirrhosis waiting for liver transplantation at 10 sites. Frailty was assessed with the liver frailty index (LFI; "frail," LFI ≥ 4.4). Cognition was assessed at the same visit with the number connection test (NCT); continuous "impaired cognition" was examined in primary analysis, with longer NCT (more seconds) indicating worse impaired cognition. For descriptive statistics, "impaired cognition" was NCT ≥ 45 seconds. Linear regression associated frailty and impaired cognition; competing risk regression estimated subhazard ratios (sHRs) of wait-list mortality (i.e., death/delisting for sickness). Median NCT was 41 seconds, and 42% had impaired cognition. Median LFI (4.2 vs. 3.8) and rates of frailty (38% vs. 20%) differed between those with and without impaired cognition. In adjusted analysis, every 10-second NCT increase associated with a 0.08-LFI increase (95% confidence interval [CI], 0.07-0.10). In univariable analysis, both frailty (sHR, 1.63; 95% CI, 1.43-1.87) and impaired cognition (sHR, 1.07; 95% CI, 1.04-1.10) associated with wait-list mortality. After adjustment, frailty but not impaired cognition remained significantly associated with wait-list mortality (sHR, 1.55; 95% CI, 1.33-1.79). Impaired cognition mediated 7.4% (95% CI, 2.0%-16.4%) of the total effect of frailty on 1-year wait-list mortality. Conclusion: Patients with cirrhosis with higher impaired cognition displayed higher rates of physical frailty, yet frailty independently associated with wait-list mortality while impaired cognition did not. Our data provide evidence for using the LFI to understand mortality risk in patients with cirrhosis, even when concurrent impaired cognition varies.
PMCID:8710786
PMID: 34558844
ISSN: 2471-254x
CID: 5127682

Motivations and outcomes of compatible living donor-recipient pairs in paired exchange

Chipman, Valerie; Cooper, Matthew; Thomas, Alvin G; Ronin, Matthew; Lee, Brian; Flechner, Stuart; Leeser, David; Segev, Dorry L; Mandelbrot, Didier A; Lunow-Luke, Tyler; Syed, Shareef; Hil, Garet; Freise, Chris E; Waterman, Amy D; Roll, Garrett R
Increasing numbers of compatible pairs are choosing to enter paired exchange programs, but motivations, outcomes, and system-level effects of participation are not well described. Using a linkage of the Scientific Registry of Transplant Recipients and National Kidney Registry, we compared outcomes of traditional (originally incompatible) recipients to originally compatible recipients using the Kaplan-Meier method. We identified 154 compatible pairs. Most pairs sought to improve HLA matching. Compared to the original donor, actual donors were younger (39 vs. 50 years, p < .001), less often female (52% vs. 68%, p < .01), higher BMI (27 vs. 25 kg/m², p = .03), less frequently blood type O (36% vs. 80%, p < .001), and had higher eGFR (99 vs. 94 ml/min/1.73 m², p = .02), with a better LKDPI (median 7 vs. 22, p < .001). We observed no differences in graft failure or mortality. Compatible pairs made 280 additional transplants possible, many in highly sensitized recipients with long wait times. Compatible pair recipients derived several benefits from paired exchange, including better donor quality. Living donor pairs should receive counseling regarding all options available, including kidney paired donation. As more compatible pairs choose to enter exchange programs, consideration should be given to optimizing compatible pair and hard-to-transplant recipient outcomes.
PMID: 34467618
ISSN: 1600-6143
CID: 5127592

The benefit to waitlist patients in a national paired kidney exchange program: Exploring characteristics of chain end living donor transplants

Osbun, Nathan; Thomas, Alvin G; Ronin, Mathew; Cooper, Matthew; Flechner, Stuart M; Segev, Dorry L; Veale, Jeffrey L
Nondirected kidney donors can initiate living donor chains that end to patients on the waitlist. We compared 749 National Kidney Registry (NKR) waitlist chain end transplants to other transplants from the NKR and the Scientific Registry of Transplant Recipients between February 2008 and September 2020. Compared to other NKR recipients, chain end recipients were more often older (53 vs. 52 years), black (32% vs. 15%), publicly insured (71% vs. 46%), and spent longer on dialysis (3.0 vs. 1.0 years). Similar differences were noted between chain end recipients and non-NKR living donor recipients. Black patients received chain end kidneys at a rate approaching that of deceased donor kidneys (32% vs. 34%). Chain end donors were older (52 vs. 44 years) with slightly lower glomerular filtration rates (93 vs. 98 ml/min/1.73 m2 ) than other NKR donors. Chain end recipients had elevated risk of graft failure and mortality compared to control living donor recipients (both p < .01) but lower graft failure (p = .03) and mortality (p < .001) compared to deceased donor recipients. Sharing nondirected donors among a multicenter network may improve the diversity of waitlist patients who benefit from living donation.
PMCID:8720056
PMID: 34212501
ISSN: 1600-6143
CID: 5127382

Waitlist outcomes for liver waitlist candidates 1-year following the implementation of MMAT/250 score [Meeting Abstract]

Ishaque, Tanveen; Beckett, James; Wang, Jacqueline; Karhadkar, Sunil; Segev, Dorry; Massie, Allan
ISI:000739470700004
ISSN: 1600-6135
CID: 5133482

Effect of Post-Kidney Transplantation BMI Trajectories [Meeting Abstract]

Bendersky, Victoria; Liu, Yi; Chen, Xiaomeng; Harhay, Meera; Segev, Dorry; McAdams-DeMarco, Mara
ISI:000739470700036
ISSN: 1600-6135
CID: 5133552

Development and Validation of a Light-Touch Frailty Phenotype for Clinical Use [Meeting Abstract]

Chen, Xiaomeng; Alasfar, Sami; Xue, Qian-Li; Norman, Silas; Walston, Jeremy; Segev, Dorry; McAdams-DeMarco, Mara
ISI:000739470700047
ISSN: 1600-6135
CID: 5133562

Evaluation of Diabetes-Free Life Expectancy Among Living Kidney Donors and Non-Donors with Obesity: A Longitudinal Cohort Study. [Meeting Abstract]

Killian, C.; Reed, R.; McLeod, M.; MacLennan, P.; Kumar, V.; Brooks, S.; Maynor, A.; Stanford, L.; Baker, G.; Schinstock, C.; Silkensen, J.; Roll, G.; Segev, D.; Orandi, B.; Lewis, C.; Locke, J.
ISI:000842606302099
ISSN: 1600-6135
CID: 5521262

CT measurements of body composition before liver transplant: How are they correlated with post-transplant outcomes? [Meeting Abstract]

Liu, Yi; Shafaat, Omid; Jackson, Kyle; Motter, Jennifer; Boyarsky, Brian; Latif, Muhammad; Yuan, Frank; King, Elizabeth; Zaheer, Atif; Summers, Ronald; Segev, Dorry; McAdams-DeMarco, Mara; Weiss, Clifford
ISI:000739470700090
ISSN: 1600-6135
CID: 5133592

Effect of Mycophenolate Mofetil Dosing on Antibody Response to SARS-CoV-2 Vaccination in Solid Organ Transplant Recipients [Meeting Abstract]

Mitchell, Jonathan; Alejo, Jennifer; Chiang, Teresa P-Y; Chang, Amy; Boyarsky, Brian; Abedon, Aura; Avery, Robin; Tobian, Aaron; Massie, Allan; Garonzik-Wang, Jacqueline; Segev, Dorry; Werbel, William
ISI:000739470700093
ISSN: 1600-6135
CID: 5133602