EARLY INCREASE IN PLASMA PARATHYROID-HORMONE LEVELS FOLLOWING LIVER-TRANSPLANTATION

Background/Aims: The pathogenesis of post-transplantation bone loss is poorly understood, although glucocorticoid therapy is believed ti, pl ay an important role, In the present study we have measured plasma par athyroid hormone concentrations in the first few months after orthotop ic liver transplantation, in order to examine the potential contributi on of hyperparathyroidism to bone disease, Patients and Methods: Twent y-seven patients aged 32-54 years, 12 male, undergoing liver transplan tation were studied prospectively before and for 3 months after operat ion, Plasma parathyroid hormone and serum 25-hydroxyvitamin D concentr ations were measured by radioimmunoassay, Results: Plasma parathyroid hormone levels were normal in all but two patients prior to transplant ation, There was a highly significant increase in plasma parathyroid h ormone concentrations at 1 and 2 months (p<0.0005 and 0.001, respectiv ely, versus baseline); by 3 months, values were close to those obtaine d preoperatively, Serum 25-hydroxyvitamin D concentrations showed no s ignificant change over the study period, However, 74% of the patients had subnormal values at baseline, Conclusions: An early and transient increase in plasma parathyroid hormone after liver transplantation may be responsible for the high rates of bone loss which occur during the first few post-operative months, Prevention of post-transplantation b one disease is most likely to be achieved by peri-operative interventi on with an anti-resorptive agent.