Hypercalcemia after Renal Transplantation

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Abstract
In 64 patients followed for more than one year after renal transplantation hypercalcemia occurred in more than 1/3 of those whose creatinine clearances reached levels greater than 30 ml per minute. The onset of the hypercalcemia occurred between one day and one year after transplantation, the severity of the hypercalcemia being worse in the first two weeks after operation. Once hypercalcemia became manifest it persisted in some cases as long as two to three years after transplantation. Evidence of persistent secondary hyperparathyroidism with raised serum parathyroid hormone was noted in all the hypercalcemic patients as long as two to three years after transplantation. Good renal function, hypophosphatemia and resolution of soft-tissue calcification also contributed to the frequency and severity of the hypercalcemia. Severe hypercalcemia (calcium concentrations of 13 mg per 100 ml and above) necessitated subtotal parathyroidectomy in four patients because of adverse effects on renal function. Persistent mild to moderate hypercalcemia (calcium concentration of 12 mg per 100 ml or less), despite its duration, was easily managed by oral phosphate supplements, without adverse effects on graft function or renal osteodystrophy. (N Engl J Med 289:398–401, 1973)