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Bone Disease after Kidney Transplantation

  • Anna L. Zisman
    Affiliations
    Division of Nephrology and Hypertension, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL
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  • Stuart M. Sprague
    Correspondence
    Address correspondence to Stuart M. Sprague, DO, Professor of Medicine, Northwestern University Feinberg School of Medicine, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201.
    Affiliations
    Division of Nephrology and Hypertension, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, IL
    Search for articles by this author
      Advances in immunosuppressive therapy have allowed for enhanced allograft survival in kidney transplantation. With this increasing success of transplantation, however, has come a greater appreciation of subsequent complications, such as bone and mineral disease. In patients with chronic kidney disease who are awaiting transplantation, disorders in mineral metabolism and renal osteodystrophy are an essentially universal finding, and several different pathophysiologic mechanisms are believed to contribute to the development of these disorders.

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      References

        • Stehman-Breen C.O.
        • Sherrard D.J.
        • Alem A.M.
        • et al.
        Risk factors for hip fracture among patients with end-stage renal disease.
        Kidney Int. 2000; 58: 2200-2205
        • Alem A.M.
        • Sherrard D.J.
        • Gillen D.L.
        • et al.
        Increased risk of hip fracture among patients with end-stage renal disease.
        Kidney Int. 2000; 58: 396-399
        • Ball A.M.
        • Gillen D.L.
        • Sherrard D.
        • et al.
        Risk of hip fracture among dialysis and renal transplant recipients.
        JAMA. 2002; 288: 3014-3018
        • Elmstedt E.
        • Svahn T.
        Skeletal complications following renal transplantation.
        Acta Orthop Scand. 1981; 52: 279-286
        • Davidson J.K.
        • Tsakiris D.
        • Briggs J.D.
        • et al.
        Osteonecrosis and fractures following renal transplantation.
        Clin Radiol. 1985; 36: 27-35
        • Ramsey-Goldman R.R.
        • Dunn J.E.
        • Dunlop D.D.
        • et al.
        Increased risk of fracture in patients receiving solid organ transplants.
        J Bone Miner Res. 1999; 14: 456-463
        • Arlen D.J.
        • Lambert K.
        • Ioannidis G.
        • et al.
        Treatment of established bone loss after renal transplantation with etidronate.
        Transplantation. 2001; 71: 669-673
        • O’Shaughnessy E.A.
        • Dahl D.C.
        • Smith C.L.
        • et al.
        Risk factors for fractures in kidney transplantation.
        Transplantation. 2002; 74: 362-366
        • Durieux S.
        • Mercadal L.
        • Orcel P.
        • et al.
        Bone mineral density and fracture prevalence in long-term kidney graft recipients.
        Transplantation. 2002; 74: 496-500
        • Grotz W.H.
        • Mundinger F.A.
        • Gugel B.
        • et al.
        Bone fracture and osteodensitometry with dual energy x-ray absorptiometry in kidney transplant recipients.
        Transplantation. 1994; 58: 912-915
        • Parker C.R.
        • Freemont A.J.
        • Blackwell P.J.
        • et al.
        Cross-sectional analysis of renal transplantation osteoporosis.
        J Bone Miner Res. 1999; 14: 1943-1951
        • Patel S.
        • Kwan J.T.C.
        • McCloskey E.
        • et al.
        Prevalence and causes of low bone density and fractures in kidney transplant patients.
        J Bone Miner Res. 2001; 16: 1863-1870
        • D’Angelo A.
        • Calo L.
        • Giannini S.
        • et al.
        Parathyroid hormone and bone metabolism in kidney-transplanted patients.
        Clin Nephrol. 2000; 53: 19-22
        • Nam J.H.
        • Moon J.I.
        • Chung S.S.
        • et al.
        Prevalence and risk factors for vertebral fractures in renal transplants.
        Transplant Proc. 2000; 32: 1877
        • Chiu M.Y.
        • Sprague S.M.
        • Bruce D.S.
        • et al.
        Analysis of fracture prevalence in kidney-pancreas allograft recipients.
        J Am Soc Nephrol. 1998; 9: 677-683
        • Nisbeth U.
        • Lindh E.
        • Ljunghall S.
        • et al.
        Increased fracture rate in diabetes mellitus and females after renal transplantation.
        Transplantation. 1999; 67: 1218-1222
        • Abbott K.C.
        • Oglesby R.J.
        • Hypolite I.O.
        • et al.
        Hospitalizations for fractures after renal transplantation in the United States.
        Epidemiology. 2001; 11: 450-457
        • Kwan J.T.
        • Almond M.K.
        • Evans K.
        • et al.
        Changes in total body bone mineral content and regional bone mineral density in renal patients following renal transplantation.
        Miner Electrolyte Metab. 1992; 18: 166-168
        • Feber J.
        • Cochat P.
        • Braillon P.
        • et al.
        Bone mineral density after renal transplantation in children.
        J Pediatr. 1994; 6: 870-875
        • McIntyre H.D.
        • Menzies B.
        • Rigby R.
        • et al.
        Long-term bone loss after renal transplantation.
        Clin Transplant. 1995; 9: 20-24
        • Torres A.
        • Machado M.
        • Concepcion M.T.
        • et al.
        Influence of vitamin D receptor genotype on bone mass changes after renal transplantation.
        Kidney Int. 1996; 50: 1726-1733
        • Yun Y.S.
        • Kim B.J.
        • Hong S.P.
        • et al.
        Changes of bone metabolism indices in patients receiving immunosuppressive therapy including low doses of steroids after renal transplantation.
        Transplant Proc. 1996; 28: 1561-1564
        • Kim M.S.
        • Kim Y.S.
        • Lim S.K.
        • et al.
        Effect of deflazacort on bone mineral density in renal transplant recipients.
        Transplant Proc. 1998; 30: 3041-3042
        • Lippuner K.
        • Casez J.-P.
        • Horber F.F.
        • et al.
        Effects of deflazacort versus prednisone on bone mass, body composition and lipid profile.
        J Clin Endocrinol Metab. 1998; 83: 3795-3802
        • Smets Y.F.C.
        • van der Pijl J.W.
        • Ringers J.
        • et al.
        Pattern of bone loss after simultaneous pancreas-kidney transplantation.
        Transplant Proc. 1998; 30: 326
        • Isiklar I.
        • Akin O.
        • Demirag A.
        • et al.
        Changes in bone mineral density after renal transplantation.
        Transplant Proc. 1998; 30 (814–185)
        • Moreno A.
        • Torregrosa J.V.
        • Pons F.
        • et al.
        Bone mineral density after renal transplantation.
        Transplant Proc. 1999; 31: 2322-2323
        • Fan S.L.S.
        • Almond M.K.
        • Ball E.
        • et al.
        Pamidronate therapy as prevention of bone loss following renal transplantation.
        Kidney Int. 2000; 57: 684-690
        • Nam J.-H.
        • Moon J.I.
        • Chung S.-S.
        • et al.
        Pamidronate and calcitriol trial for the prevention of early bone loss after renal transplantation.
        Transplant Proc. 2000; 32: 1876
        • Kokado Y.
        • Takahara S.
        • Ichimaru N.
        • et al.
        Factors influencing vertebral bone density after renal transplantation.
        Transpl Int. 2000; 13: S431-S435
        • Goffin E.
        • Devogelaer J.-P.
        • Lalaoui A.
        • et al.
        Tacrolimus and low-dose steroid immunosuppression preserves bone mass after renal transplantation.
        Transpl Int. 2002; 15: 73-80
        • Julian B.A.
        • Laskow D.A.
        • Dubovsky J.
        • et al.
        Rapid loss of vertebral mineral density after renal transplantation.
        N Engl J Med. 1991; 325: 544-550
        • Horber F.F.
        • Casez J.P.
        • Steiger U.
        • et al.
        Changes in bone mass early after kidney transplantation.
        J Bone Miner Res. 1994; 9: 1-9
        • Almond M.K.
        • Kwan J.T.
        • Evans K.
        • et al.
        Loss of regional bone mineral density in the first 12 months following renal transplantation.
        Nephron. 1994; 66: 52-57
        • Grotz W.
        • Nagel C.
        • Poeschel D.
        • et al.
        Effect of ibandronate on bone loss and renal function after kidney transplantation.
        J Am Soc Nephrol. 2001; 12: 1530-1537
        • Grotz W.H.
        • Mundinger F.A.
        • Gugel B.
        • et al.
        Bone mineral density after kidney transplantation. A cross-sectional study in 190 graft recipients up to 20 years after transplantation.
        Transplantation. 1995; 59: 982-986
        • Ugur A.
        • Guvener N.
        • Isiklar I.
        • et al.
        Osteoporosis after renal transplantation.
        Transplantation. 2001; 71: 645-649
        • Nowacka-Cieciura E.
        • Durlik M.
        • Cieciura T.
        • et al.
        Steroid withdrawal after renal transplantation-risks and benefits.
        Transplant Proc. 2002; 34: 560-563
        • Aroldi A.
        • Tarantino A.
        • Montagnino G.
        • et al.
        Effects of three immunosuppressive regimens on vertebral bone density in renal transplant recipients.
        Transplantation. 1997; 63: 380-386
        • Bagni B.
        • Gilli P.
        • Cavallini A.
        • et al.
        Continuing loss of vertebral mineral density in renal transplant recipients.
        Eur J Nucl Med. 1994; 21: 108-112
        • Hurst G.
        • Alloway R.
        • Hathaway D.
        • et al.
        Stabilization of bone mass after renal transplant with preemptive care.
        Transplant Proc. 1998; 30: 1327-1328
        • Yazawa K.
        • Ishikawa T.
        • Ichikawa Y.
        • et al.
        Positive effects of kidney transplantation on bone mass.
        Transplant Proc. 1998; 30: 3031-3033
        • Kim H.
        • Chang K.
        • Lee T.
        • et al.
        Bone mineral density after renal transplantation.
        Transplant Proc. 1998; 30: 3029-3030
        • Cueto-Manzano A.M.
        • Konel S.
        • Freemont A.J.
        • et al.
        Effect of 1,25-dihydroxyvitamin D3 and calcium carbonate on bone loss associated with long-term renal transplantation.
        Am J Kidney Dis. 2000; 35: 227-236
        • Grotz W.H.
        • Rump L.C.
        • Niessen A.
        • et al.
        Treatment of osteopenia and osteoporosis after kidney transplantation.
        Transplantation. 1998; 66: 1004-1008
        • Cruz D.
        • Wysolmerski J.J.
        • Brickel H.
        • et al.
        Parameters of high bone-turnover predict bone loss in renal transplant patients.
        Transplantation. 2001; 72: 83-88
        • Brandenburg V.M.
        • Ketteler M.
        • Fassbender W.J.
        • et al.
        Development of lumbar bone mineral density in the late course after kidney transplantation.
        Am J Kidney Dis. 2002; 40: 1066-1074
        • Smets Y.F.
        • van der Pilj J.W.
        • de Fijter J.W.
        • et al.
        Low bone mass and high incidence of fractures after successful simultaneous pancreas-kidney transplantation.
        Nephrol Dial Transplant. 1998; 13: 1250-1255
        • Velasquez-Forero F.
        • Mondragon A.
        • Herrero B.
        • et al.
        Adynamic bone lesion in renal transplant recipients with normal renal function.
        Nephrol Dial Transplant. 1996; 11: 58-64
        • Braun W.E.
        • Richmond B.J.
        • Protiva D.A.
        • et al.
        The incidence and management of osteoporosis, gout, and avascular necrosis in recipients of renal allografts functioning more than 20 years (level 5A) treated with prednisone and azathioprine.
        Transplant Proc. 1999; 31: 1366-1369
        • Carlini R.G.
        • Rojas E.
        • Weisinger J.R.
        • et al.
        Bone disease in patients with long-term renal transplantation and normal renal function.
        Am J Kidney Dis. 2000; 36: 160-166
        • Heaf J.
        • Tvedgaard E.
        • Kanstrup I.-L.
        • et al.
        Bone loss after renal transplantation.
        Clin Transplant. 2000; 14: 457-463
        • Ellis E.N.
        • Floyd-Gimon D.M.
        • Berry P.L.
        • et al.
        Risk factors for bone mineral density loss in pediatric renal transplant patients.
        Pediatr Transplantat. 2000; 4: 146-150
        • Cayco A.V.
        • Wysolmerski J.
        • Simpson C.
        • et al.
        Posttransplant bone disease.
        Transplantation. 2000; 70: 1722-1728
        • Kovac D.
        • Lindic J.
        • Kandus A.
        • et al.
        Bone mineral density in kidney transplant recipients.
        Transplant Proc. 2001; 33: 3668-3669
        • Pichette V.
        • Bonnardeaux A.
        • Prudhomme L.
        • et al.
        Long-term bone loss in kidney transplant recipients.
        Am J Kidney Dis. 1996; 28: 105-114
        • Wolpaw T.
        • Deal C.L.
        • Fleming-Brooks S.
        • et al.
        Factors influencing vertebral bone density after renal transplantation.
        Transplantation. 1994; 58: 1186-1189
        • Boiskin I.
        • Epstein S.
        • Ismail F.
        • et al.
        Serum osteocalcin and bone mineral metabolism following successful renal transplantation.
        Clin Nephrol. 1989; 31: 316-322
        • Schmidt H.
        • Stracke H.
        • Schatz H.
        • et al.
        Osteocalcin serum levels in patients following renal transplantation.
        Klin Wochenschr. 1989; 67: 297-303
        • Saha H.H.
        • Salmela K.T.
        • Ahonen P.J.
        • et al.
        Sequential changes in vitamin D and calcium metabolism after successful renal transplantation.
        Scand J Urol Nephrol. 1994; 28: 21-27
        • Withold W.
        • Degenhardt S.
        • Heins M.
        • et al.
        Monitoring of bone resorption after renal transplantation by measuring the urinary excretion of pyridinium cross-links.
        Eur J Clin Chem Clin Biochem. 1995; 33: 15-21
        • Bonnin M.R.
        • Gonzalez M.T.
        • Grino J.M.
        • et al.
        Changes in serum osteocalcin levels in the follow-up of kidney transplantation.
        Ann Clin Biochem. 1997; 34: 651-655
        • Barbarykin D.
        • Adamsone I.
        • Amerika D.
        • et al.
        Disorders of calcium metabolism at various times after renal transplantation.
        Ann Transplant. 1999; 4: 46-53
        • Kusec V.
        • Smalcelj R.
        • Cvijetic S.
        • et al.
        Determinants of reduced bone mineral density and increased bone turnover after kidney transplantation.
        Croat Med J. 2000; 41: 396-400
        • Westeel F.P.
        • Mazouz H.
        • Ezaitouni F.
        • et al.
        Cyclosporine bone remodeling effect prevents steroid osteopenia after kidney transplantation.
        Kidney Int. 2000; 58: 1788-1796
        • Cundy T.
        • Kanis J.A.
        Rapid suppression of plasma alkaline phosphatase activity after renal transplantation in patients with osteodystrophy.
        Clin Chim Acta. 1987; 164: 285-291
        • van Straalen J.P.
        • Sanders E.
        • Prummel M.F.
        • et al.
        Bone-alkaline phosphatase as indicator of bone formation.
        Clin Chim Acta. 1991; 201: 27-33
        • Withold W.
        • Friedrich W.
        • Degenhardt S.
        Serum bone alkaline phosphatase is superior to plasma levels of bone matrix proteins for assessment of bone metabolism in patients receiving renal transplants.
        Clin Chim Acta. 1997; 261: 105-115
        • Withold W.
        • Degenhardt S.
        • Grabensee B.
        • et al.
        Comparison between serum levels of bone alkaline phosphatase and the carboxy-terminal propeptide of type I procollagen as markers of bone formation in patients following renal transplantation.
        Clin Chim Acta. 1995; 239: 143-151
        • Epstein S.
        • Traberg H.
        • Raja R.
        • et al.
        Serum and dialysate osteocalcin levels in hemodialysis and peritoneal dialysis patients and after renal transplantation.
        J Clin Endocrinol Metab. 1985; 60: 1253-1256
        • Reusz G.S.
        • Szabo A.J.
        • Peter F.
        • et al.
        Bone metabolism and mineral density following renal transplantation.
        Arch Dis Child. 2000; 83: 146-151
        • Pietschmann P.
        • Vychytil A.
        • Woloszczuk W.
        • et al.
        Bone metabolism in patients with functioning kidney grafts.
        Nephron. 1991; 59: 533-536
        • Amado J.A.
        • Riancho J.A.
        • De Francisco A.L.
        • et al.
        Hyperparathyroidism is responsible for the increased levels of osteocalcin in patients with normally functioning kidney grafts.
        Nephron. 1989; 52: 209-215
        • Dumoulin G.
        • Hory B.
        • Nguyen N.U.
        • et al.
        No trend toward a spontaneous improvement of hyperparathyroidism and high bone turnover in normocalcemic long-term renal transplant recipients.
        Am J Kidney Dis. 1997; 29: 746-753
        • Giannini S.
        • D’Angelo A.
        • Carraro G.
        • et al.
        Persistently increased bone turnover and low bone density in long-term survivors to kidney transplantation.
        Clin Nephrol. 2001; 56: 353-363
        • Briner V.A.
        • Thiel G.
        • Monier-Faugere M.C.
        • et al.
        Prevention of cancellous bone loss but persistence of renal bone disease despite normal 1,25 vitamin D levels two years after kidney transplantation.
        Transplantation. 1995; 59: 1393-1400
        • Carlini R.G.
        • Rojas E.
        • Arminio A.
        • et al.
        What are the bone lesions in patients with more than four years of a functioning renal transplant?.
        Nephrol Dial Transplant. 1998; 13: 103-104
        • Cueto-Manzano A.M.
        • Konel S.
        • Hutchison A.J.
        • et al.
        Bone loss in long-term renal transplantation.
        Kidney Int. 1999; 55: 2021-2029
        • Sanchez C.P.
        • Salusky I.B.
        • Kuizon B.D.
        • et al.
        Bone disease in children and adolescents undergoing successful renal transplantation.
        Kidney Int. 1998; 53: 1358-1364
        • Weisinger J.R.
        • Carlini R.G.
        • Rojas E.
        • et al.
        Bone disease after renal transplantation.
        Transplant Proc. 1999; 31: 3033-3034
        • Monier-Faugere M.C.
        • Mawad H.
        • Qi Q.
        • et al.
        High prevalence of low bone turnover and occurrence of osteomalacia after kidney transplantation.
        J Am Soc Nephrol. 2000; 11: 1093-1099
        • Parker C.R.
        • Blackwell P.J.
        • Freemont A.J.
        • et al.
        Biochemical measurements in the prediction of histologic subtype of renal transplant bone disease in women.
        Am J Kidney Dis. 2002; 40: 385-396
        • Rojas E.
        • Carlini R.G.
        • Clesca P.
        • et al.
        The pathogenesis of osteodystrophy after renal transplantation as detected by early alterations in bone remodeling.
        Kidney Int. 2003; 63: 1915-1923
        • Rubin M.R.
        • Bilezikian J.P.
        Clinical review 151: The role of parathyroid hormone in the pathogenesis of glucocorticoid-induced osteoporosis: A re-examination of the evidence.
        J Clin Endocrinol Metab. 2002; 87: 4033-4041
        • Epstein S.
        Post-transplantation bone disease.
        J Bone Miner Res. 1996; 11: 1-7
        • Stewart P.J.
        • Stern P.H.
        Cyclosporines.
        Calcif Tissue Int. 1989; 45: 222-226
        • Stewart P.J.
        • Stern P.H.
        Interaction of cyclosporine A and calcitonin on bone resorption in vitro.
        Horm Metab Res. 1989; 21: 194-197
        • Cuerto-Manzano A.M.
        • Konel S.
        • Crowley V.
        • et al.
        Bone histopathology and densitometry comparison between Cyclosporine A monotherapy and prednisolone plus azathioprine dual immunosuppression in renal transplant recipients.
        Transplantation. 2003; 75: 2053-2058
        • Josephson M.A.
        • Schumm L.P.
        • Chiu M.Y.
        • et al.
        Calcium and calcitriol prophylaxis against post-transplant bone loss.
        Transplantation. 2004; 78: 1233-1236
        • Bowman A.R.
        • Sass D.A.
        • Dissanayake I.R.
        • et al.
        The role of testosterone in cyclosporine-induced osteopenia.
        J Bone Miner Res. 1997; 12: 607-615
        • Epstein S.
        • Dissanayake I.R.
        • Goodman G.R.
        • et al.
        Effect of the interaction of parathyroid hormone and cyclosporine a on bone mineral metabolism in the rat.
        Calcif Tissue Int. 2001; 68: 240-247
        • Awumey E.M.
        • Moonga B.S.
        • Sodam B.R.
        • et al.
        Molecular and functional evidence for calcineurin-A alpha and beta isoforms in the osteoclast.
        Biochem Biophys Res Commun. 1999; 254: 248-252
        • Buchinsky F.J.
        • Ma Y.
        • Mann G.N.
        • et al.
        T lymphocytes play a critical role in the development of cyclosporine A-induced osteopenia.
        Endocrinology. 1996; 137: 2278-2285
        • Ponticelli C.
        • Aroldi A.
        Osteoporosis after organ transplantation.
        Lancet. 2001; 357: 1623
        • Grotz W.
        • Mundinger A.
        • Gugel B.
        • et al.
        Missing impact of cyclosporine on osteoporosis in renal transplant recipients.
        Transplant Proc. 1994; 26: 2652-2653
        • Kirino S.
        • Fukunaga J.
        • Ikegami S.
        • et al.
        Regulation of bone metabolism in immunosuppresant (FK 506)– treated rats.
        J Bone Miner Metab. 2004; 22: 554-560
        • Monegal A.
        • Navasa M.
        • Guanabens N.
        • et al.
        Bone mass and mineral metabolism in liver transplant patients treated with FK506 or cyclosporine A.
        Calcif Tissue Int. 2001; 68: 83-86
        • Sambrook P.
        Alfacalcidol and calcitriol in the prevention of bone loss after organ transplantation.
        Calcif Tissue Int. 1999; 65: 341-343
        • Lippuner K.
        • Haller B.
        • Casez J.P.
        • et al.
        Effect of disodium monofluorophosphate, calcium and vitamin D supplementation on bone mineral density in patients chronically treated with glucocorticosteroids.
        Miner Electrolyte Metab. 1996; 22: 207-213
        • Meys E.
        • Terreaux-Duvert F.
        • Beaume-Six T.
        • et al.
        Bone loss after cardiac transplantation.
        Osteoporos Int. 1993; 3: 322-329
        • Garcia-Delgado I.
        • Prieto S.
        • Gil-Fraguas L.
        • et al.
        Calcitonin, etidronate, and calcidiol treatment in bone loss after cardiac transplantation.
        Calcif Tissue Int. 1997; 60: 155-159
        • Smets Y.F.
        • de Fijter J.W.
        • Ringers J.
        • et al.
        Long term follow-up study on bone mineral density and fractures after simultaneous pancreas-kidney transplantation.
        Kidney Int. 2004; 66: 2070-2076
        • Coco M.
        • Glicklich D.
        • Faugere M.C.
        • et al.
        Prevention of bone loss in renal transplant recipients.
        J Am Soc Nephrol. 2003; 14: 2669-2676
        • Kovac D.
        • Lindic J.
        • Kandus A.
        • et al.
        Prevention of bone loss in kidney graft recipients.
        Transplant Proc. 2001; 33: 1144-1145
        • Giannini S.
        • D’Angelo A.
        • Carraro G.
        • et al.
        Alendronate prevents further bone loss in renal transplant recipients.
        J Bone Miner Res. 2001; 16: 2111-2117
        • Haas M.
        • Leko-Mohr Z.
        • Roschger P.
        • et al.
        Zoledronic acid to prevent bone loss in the first 6 months after renal transplantation.
        Kidney Int. 2003; 63: 1130-1136
        • Jeffrey J.R.
        • Leslie W.D.
        • Karpinski M.E.
        • et al.
        Prevalence and treatment of decreased bone density in renal transplant recipients.
        Transplantation. 2003; 76: 1498-1502
        • Lee S.
        • Glicklich D.
        • Coco M.
        Pamidronate used to attenuate post-renal transplant bone loss is not associated with renal dysfunction.
        Nephrol Dial Transplant. 2004; 19: 2870-2873
        • Kruse A.E.
        • Eisenberger U.
        • Frey F.J.
        • et al.
        The calcimimetic cinacalcet normalizes serum calcium in renal transplant patients with persistent hyperparathyroidism.
        Nephrol Dial Transplant. 2005; 20: 1311-1314
        • Tang I.
        • Josephson M.A.
        • Kopyt N.
        • et al.
        Cinacalcet in post-transplant hyperparathyroidism.
        J Am Soc Nephrol. 2005; 16: 500A
        • Serra A.L.
        • Schwarz A.A.
        • Wick F.H.
        • et al.
        Successful treatment of hypercalcemia with cinacalcet in renal transplant recipients with persistent hyperparathyroidism.
        Nephrol Dial Transplant. 2005; 20: 1315-1319