MON-811 - Impact of Transplant Endocrinology Co-Management on Mineral and Bone Disorders Outcomes in Adults with Diabetes Mellitus Receiving Kidney Transplant

Background:
Mineral and bone disorders (MBD) are common conditions affecting patients with end-stage kidney disease (ESRD) receiving kidney transplant; however, the role of a specialized transplant endocrinology co-management service with nephrology remains underexplored or inconsistent [1]. Thus, a pilot initiative was developed for patients with diabetes mellitus (DM) undergoing kidney transplant as they are at increased risk of fracture post-transplantation [2].

Methods:
A retrospective cohort study was performed on adults (age ≥18) with DM and ESRD receiving kidney transplant at a single academic medical center between 12/1/2021 and 12/31/2024. We compared those patients who received specialized transplant endocrinology co-management (n=101, TxEndo) to those who received standard of care with transplant nephrology only (n=80, SOC). We evaluated DXA utilization, fracture presence, osteoporosis pharmacotherapy use, and MBD laboratory markers (serum calcium, phosphorus, 25-OH vitamin D, alkaline phosphatase, parathyroid hormone) pre-and post-kidney transplant. Fracture presence was defined based on radiologic reports and electronic medical records.

Results:
The mean age of kidney transplant recipient was 61 years old for both groups. Patients were majority men, overweight, and received deceased donor transplants. Under transplant endocrinology care, more patients had DXA scans performed pre- and post-transplant compared to those receiving standard of care (pre-transplant: 4.9% TxEndo, 3.8% SOC; post-transplant: 11.9% TxEndo, 3.8% SOC). Pre-transplant intact PTH level was lower in the transplant endocrinology group (338.9186.4 pg/ml TxEndo, 475.2 9293 SOC, p=0.002) but otherwise no significant differences between groups were seen for the remaining laboratory markers. Despite experiencing more fractures pre-transplant, those receiving endocrinology co-management developed fewer fractures post-transplant (pre-transplant: 28.7% TxEndo, 20.0% SOC; post-transplant: 4.0% TxEndo, 6.3% SOC). No patients received osteoporosis pharmacotherapy post-transplant during study period.

Conclusions:
Under transplant endocrinology co-management, adults with DM and MBD experienced fewer incident fractures and increased DXA monitoring post-transplant compared to those receiving standard of care. However, the use of osteoporosis pharmacotherapy was limited despite fracture presence. Thus, this pilot initiative supports the implementation of transplant endocrinology service with formalized protocol to reduce incident new fractures post kidney transplant.

References:
1. Pellegrini B. Awareness of post-transplant endocrine disorders among kidney transplant clinicians. J Endocrinol Invest. 2025.
2. Rakel A. Does diabetes increase the risk for fractures after solid organ transplantation? J Bone Miner Res. 2007.

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