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Aseptic bone necrosis after renal transplantation
1Department of Surgery, University of Florida, Gainesville 32610.
Surgery
|January 1, 1988
Summary
Aseptic necrosis (ASN) after kidney transplants is linked to pre-existing bone conditions and early rejection. Higher steroid doses and black recipients show increased risk for this complication.
Area of Science:
- Nephrology
- Orthopedics
- Transplantation Medicine
Background:
- Osteonecrosis, specifically aseptic necrosis (ASN), is a frequent complication following renal transplantation, hindering patient rehabilitation.
- The etiology of ASN remains poorly understood, despite the long-standing suspicion of prednisone's role.
Purpose of the Study:
- To identify potential etiologic factors contributing to the development of aseptic necrosis (ASN) in renal transplant recipients.
- To investigate the correlation between various patient and treatment factors and the incidence of ASN.
Main Methods:
- A retrospective study analyzing 444 kidney transplant recipients between 1978 and 1984.
- Examined correlations between ASN and factors including age, sex, donor source, primary renal disease, dialysis duration, parathyroidectomy, prednisone use, race, and pre-transplant radiographic bone status.
Main Results:
- Pre-transplant radiographic evidence of osteopenia or renal osteodystrophy significantly predicted ASN (p < 0.01).
- ASN was associated with early acute rejection (p < 0.02) and higher final serum creatinine (p = 0.07).
- Increased mean prednisone dosage (p < 0.0001) and daily dose trend (p < 0.03) correlated with higher ASN incidence. Black recipients showed a trend towards increased risk (p = 0.07).
Conclusions:
- ASN is significantly more likely if radiographic bone abnormalities are present pre-transplant.
- Acute rejection and higher steroid dosages are linked to increased ASN incidence.
- Black recipients may face a higher risk of developing ASN post-renal transplantation.