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Transient bone marrow edema in renal transplantation: a distinct post-transplantation syndrome with a characteristic

P Toby H Coates1, Mark Tie, Graeme R Russ

  • 1Renal Unit, Department of Medicine, University of Adelaide, 28 Woodville Road, Woodville, Adelaide, Australia 5011.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|July 19, 2002
PubMed

Insights

Severe knee pain after renal transplant is often transient bone marrow edema. Magnetic resonance imaging (MRI) can identify these changes, which resolve without cyclosporin withdrawal.

Area of Science:

  • Nephrology
  • Orthopedics
  • Radiology

Background:

  • Renal transplantation is a life-saving procedure.
  • Post-transplant complications can impact patient quality of life.
  • Severe knee pain is an uncommon but debilitating post-transplant symptom.

Purpose of the Study:

  • To characterize the magnetic resonance imaging (MRI) findings of severe knee pain in renal transplant recipients.
  • To investigate the natural history and resolution of these MRI findings.
  • To determine if immunosuppression withdrawal is necessary.

Main Methods:

  • Case series of four renal transplant patients with severe knee pain.
  • Standard radiography and inflammatory marker assessment (CRP, ESR).
  • Magnetic resonance imaging (MRI) for detailed joint and bone marrow evaluation.
  • Clinical and radiological follow-up for up to 36 months.

Main Results:

  • All patients experienced severe knee pain within 3 months post-transplantation.
  • Radiographs and inflammatory markers were normal.
  • MRI revealed characteristic bone marrow signal changes in the knee.
  • These changes differed from avascular necrosis (AVN) and reflex sympathetic dystrophy.
  • Pain and MRI findings resolved spontaneously within 3 months without therapy or cyclosporin withdrawal.
  • No progression to AVN was observed during follow-up.

Conclusions:

  • Bone marrow edema is a likely cause of severe knee pain post-renal transplantation.
  • MRI is the key diagnostic tool for identifying these changes.
  • These MRI findings are distinct from AVN and RSD.
  • The condition is self-limiting and does not necessitate immunosuppression adjustment.
  • Cyclosporin does not need to be withdrawn for this complication.

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