Skeletal integrity and visceral transplantation

Area of Science:

• Gastroenterology
• Transplantation Medicine
• Endocrinology

Background:

• Long-term survival after intestinal transplantation is improving, but bone health risks and management remain poorly understood.
• Bone health impairment is a significant concern for intestinal transplant candidates and recipients.

Purpose of the Study:

• To investigate the prevalence of bone health issues in intestinal transplant candidates and recipients.
• To identify risk factors for bone loss and osteoporosis.
• To evaluate bone loss progression post-transplantation and assess management strategies.

Main Methods:

• Retrospective chart review of 147 adult patients (70 long-term survivors, 53 candidates, 24 recipients).
• Bone mineral density (BMD) and biochemical markers were assessed.
• Longitudinal follow-up was conducted for recipients.

Main Results:

• Both candidates and survivors exhibited low bone mass (low z-scores) and high rates of vitamin D deficiency and secondary hyperparathyroidism.
• Osteoporosis prevalence was 44% in survivors and 36% in candidates, with risk factors including age, BMD, parenteral nutrition duration, immunosuppression, and rejection.
• Fragility fractures were more common in survivors (20%) than candidates (6%).
• Bone loss accelerated post-transplantation (13.4% decline at femoral neck, 12.7% at hip).
• Alendronate partially reduced bone loss but did not prevent it.

Conclusions:

• Intestinal transplant recipients are at high risk for osteoporosis due to bone loss occurring both pre- and post-transplantation.
• Comprehensive preventive measures and prompt therapeutic interventions, including bisphosphonates or human parathyroid hormone (PTH), are recommended.