Aseptic Necrosis of Bone Following Renal Transplantation

Ls, Ibels; Ac, Alfrey; We, Huffer; Weil, R

doi:10.1097/00005792-197801000-00002

Cited by 110 publications

(6 citation statements)

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“…Aseptic necrosis of bone has been observed in 21% of our patients studied 4 to 146 months after transplantation [22]. Markedly increased susceptibility to infection is found in immunosuppressed patients, including susceptibility to a variety of opportunistic infections caused by bacteria, viruses, protozoa, and fungi.…”

Section: Immunosuppressionmentioning

confidence: 77%

“…The complications of immunosuppression include the complications of excess adrenal corticosteroid levels, hypertension, ache, obesity, diabetes mellitus, peptic ulcer, osteoporosis, and ocular cataract. Aseptic necrosis of bone has been observed in 21% of our patients studied 4 to 146 months after transplantation [22]. Markedly increased susceptibility to infection is found in immunosuppressed patients, including susceptibility to a variety of opportunistic infections caused by bacteria, viruses, protozoa, and fungi.…”

Section: Immunosuppressionmentioning

confidence: 77%

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A 14‐year experience with kidney transplantation

et al. 1977

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Between November, 1962 and August, 1975, 668 kidney transplants were done in 556 consecutive patients at Denver, Colorado. The Denver experience has been divided into 7 periods of time, according to the conditions of care during each period. The results in related transplantation have changed little during the decade beginning in 1966. The results in unrelated transplantation have not materially changed since 1968. The long-term patient survival after related transplantation has been better than after cadaver transplantation. The results of transplantation in 57 children ages 3 to 18 years have been slightly better than the results of adult transplantation.The outcome of kidney transplantation and the feasibility of improving this therapy with present techniques are limited by our inability to accurately match each patient with the immunologically best donor and by our inability to precisely control the immune system of the recipient. Rejection is still the main reason for graft loss, and sepsis remains the main cause of patient mortality. More specific and less toxic means of achieving graft acceptance are needed before a higher level of patient service can be realized. However, even with the tools now available, thousands of recipients throughout the world have been returned to useful lives.Approximately 25,000 kidney transplants were carried out and reported to the ACS/NIH kidney transplant registry prior to the dissolution of this organization in the summer of 1976. During the almost 13-year period from November, 1962 until August, 1975, 668 kidney transplants were done at the University of Colorado Medical Center and the Denver Veterans Administration Hospital. Follow-up data have been obtained on each of the 556 consecutive patients treated during this interval, with a minimum period of 1 year of post-transplant observation in the most recent cases. The Denver experience is presented to illustrate the development of kidney transplantation and as an example of current trends in the field. Methods: Denver Conditions of Care Case Material and ImmunosuppressionThe Denver kidney transplantation experience between 1962 and 1975 has been divided into seven periods according to the conditions of care rendered during these times. The characteristics of these periods are summarized in Table 1 Cadaver Kidney PreservationFrom 1962 to 1968, cadaver kidneys were harvested after cardiac standstill or from heartbeating cadavers or from cadaver donors whose circulation was being maintained by cardiopulmonary bypass. The removed organs were further cooled by infusion with chilled electrolyte solutions with or without low molecular weight dextran. From 1968 to 1971, some of the cadaver kidneys were stored in a hyperbaric oxygen chamber. From 1971 through 1975, cadaver kidneys were preserved by Belzer's machine pulsatile perfusion method using cryoprecipitated plasma. Since the beginning of 1976, cadaver kidneys which were expected to be reimplanted within 24 hours after removal from the donor have been stored in mod...

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Section: Immunosuppressionmentioning

confidence: 77%

Section: Immunosuppressionmentioning

confidence: 77%

A 14‐year experience with kidney transplantation

et al. 1977

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“…Only a few of these patients developed osteonecrosis later than 4 years after transplantation. Although some studies have shown a relationship between prednisone and the development of posttransplant osteonecrosis (Elmstedt 1982;Harrington et al 1971;Heerfordt et al 1978;Ibels et al 1978), no definite correlation between the cumulated dose of prednisone and the risk of developing osteonecrosis has been found in others (Bewick et a/. 1976;Farge et al 1985;Feletti et al 1984;Haajanen et al 1985;Lausten et al 1989;Stern &Watts 1979).…”

Section: Discussionmentioning

confidence: 99%

“…1976;Elmstedt 1981;Haajanen eta/. 1985; Harrington e t a / . Heerfordt et al 1978;Ibels et a/. 1978).…”

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Metabolism of Prednisone in Kidney Transplanted Patients with Necrosis of the Femoral Head

Lausten

Egfjord

Ølgaard

1993

Pharmacology & Toxicology

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Interindividual variation of the metabolism of prednisolone and of the susceptibility to glucocorticoids might be possible factors contributing to the development of osteonecrosis after renal allotransplantation. As this aspect has not been properly investigated previously, we compared, in the present study, the metabolism of total and free prednisolone in 6 renal allotransplanted patients who subsequently developed osteonecrosis of the femoral head and the metabolism of 6 matched controls, who did not develop osteonecrosis. There was no difference in age, bodyweight, total serum protein or albumin, or in liver or renal function. The baseline cortisol was 54 +/- 23 micrograms in patients with necrosis, and 102 +/- 53 micrograms/l in patients without necrosis (n.s.). Likewise there was no difference in the peak concentration of prednisolone (420 +/- 43 vs. 394 +/- 42 micrograms/l, n.s.), the bioavailability (0.57 +/- 0.09 vs. 0.61 +/- 0.05, n.s.) or in the apparent volume of distribution at steady state (Vdss, 0.37 +/- 0.09 vs. 0.37 +/- 0.04 l/kg, n.s.). The clearance of prednisolone in patients with osteonecrosis was 33% lower (0.79 +/- 0.11 vs. 1.18 +/- 0.13 ml/min./kg b.wt., P < 0.05) and t1/2 was correspondingly 33% longer (246 +/- 18 min. vs. 184 +/- 15 min., P < 0.05) than in patients without osteonecrosis. However, there was no difference in the apparent volume of distribution of free prednisolone (2.07 +/- 0.36 vs. 1.69 +/- 0.28 l/kg, n.s.), in the t1/2 (152 +/- 30 vs. 107 +/- 20 min., n.s.), or in the clearance (7.33 +/- 2.12 vs. 7.82 +/- 1.18 ml/min./kg) between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Ase ptische Knochennekrosen. Als Folge der Steroidmedikation sind aseptische Knochennekrosen (25,31) auch bei nierentranspiantierten Kindern gelegentlich beschrieben worden (4, 30,41,45). Wir beobachteten bei einer Patientin (Fall 13) 9 Monate nach der Transplantation einen kleinen Nekroseherd im linken Schultergelenk und subkartilaginäre Knochennekrosen an beiden distalen Femurenden, die wie eine Osteochondritis dissecans aussahen und zu erheblichen funktionellen Beschwerden führten.…”

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