Safety and Efficacy of a 3-Year Therapy With Cinacalcet in Persistent Hyperparathyroidism After Renal Transplant

Persistent post-transplant hyperparathyroidism (PPTHP) can occur in 20% to 50% of renal transplant recipients. The aim of this study was to analyze safety and efficacy of long-term cinacalcet therapy in a group of renal transplant recipients with PPTHP. A single center retrospective cohort study including renal transplant recipients, adults (>18 years old) with PPTHP and hypercalcemia. Inclusion criteria for cinacalcet therapy was increased parathormone levels (PTH > 65 pg/mL) associated with serum calcium >11.5 mg/dL any time after transplant or calcium >10.2 mg/dL within the first year after transplant. The follow-up period was 3 years. Demographic, laboratory data and adverse events were assessed. Forty-six patients were included, mean age of 50 ± 11 years old, majority of white race (60%), male (58%), with a pretransplant length on dialysis of 67 ± 34 months. Cinacalcet therapy was started 37 ± 40 months after transplant, and normal calcium levels were achieved after 6 months of therapy. PTH levels presented a steady reduction over time, reaching levels near normal after 36 months (317 ± 242 vs 145 ± 72 pg/mL, baseline × month 36, P < .05). Renal function remained stable over time (GFR > 60 mL/min/1.73 m2) and no acute rejection episodes were observed. Most common adverse events were mild gastrointestinal symptoms. In 6 patients (12.5%) treatment was interrupted due to adverse events. Only 1 case (2%) was classified as treatment failure. Cinacalcet therapy proved to be efficient for PPTHP and safe for graft and patient. Long-term treatment reduced PTH levels to near normal range. •The aim of this study was to analyze safety and efficacy of long-term cinacalcet therapy in a group of 46 renal transplant recipients with severe persistent hyperparathyroidism.•Cinacalcet was efficient to correct bone metabolism disturbance in the early period of therapy, with a quick response in serum calcium and phosphate levels. We also observed a significant reduction in PTH levels, despite the mean pretransplant PTH >1000 pg/mL, classified as severe hyperparathyroidism.•Renal function persisted stable during follow-up.•Only 1 case (2%) was considered as treatment failure, without calcium or PTH normalization despite a higher dose of cinacalcet, and patient was referred to parathyroidectomy.•Treatment with cinacalcet proved to be efficient to control hypercalcemia and normalize PTH levels, and safe for patient and graft. Treatment failure was rare and observed in 2% of t