Considering that post-KT hyperparathyroidism can arise from structural changes such as parathyroid gland hyperplasia, downregulation of calcium-sensing and vitamin D receptors, and pretransplant alterations in FGF-23 signaling, dialysis vintage may promote parathyroid hyperplasia, while pretransplant hyperphosphatemia may exacerbate CKD-MBD and lead to abnormal FGF-23 signaling. Here, VDR is linked to Marchiafava-Bignami disease.