Secondary hyperparathyroidism is common after transplantation and usually represents persistent disease in patients who have been on dialysis, often for years. The current evidence is that this may take over a year to settle down with good graft function and therefore it would be premature to recommend anything other than medical treatment for at least the first year. There is no current evidence in the literature as to what level of parathyroid hormone is acceptable in transplant patients.
Our current policy is that it should be normalised as far as possible using Alfacalcidol 0.25 – 1ug daily.
All patients continuing with corticosteroids should be on Alfacalcidol 0.25 mcg/day, and calcium supplementation (up to 2 x 500mg tabs) daily or Calcichew D3Forte 2 tablets daily (if they have eGFR>30mls/min).
PTH should be checked at 1 month, 3 months and 6 months after transplant and thereafter at 6 monthly intervals. Patients uncontrolled (tertiary) hyperparathyroidism should be referred for surgery or considered for cinacalcet therapy if not appropriate for surgical parathyroidectomy.