Avascular Necrosis of Bone after Renal Transplantation

Harrington, Kevin D.; Murray, William R.; Kountz, Samuel L.; Belzer, Folkert O.

doi:10.2106/00004623-197153020-00001

Cited by 152 publications

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“…Reported risk factors for AVN after renal transplantation include administration of steroids, the duration of dialysis before transplantation (Patton and Plaff 1988), the number of acute rejection episodes (Harrington et al 1971), hyperparathyroidism (Chatterjee et al 1976), and hypophosphatemia (Briggs et al 1972). Numerous studies have been performed at multiple facilities regarding the dose and method of steroid administration in an attempt to reduce the incidence of AVN.…”

Section: Discussionmentioning

confidence: 99%

“…Felson and Anderson (1987) examined the total dose and oral dose of steroids administered in the 1-, 3-, 6-, and 12-month periods after transplantation and found a relationship between the oral dose in each time period and development of AVN. Harrington et al (1971) examined 150 patients who had undergone renal transplantation. Of 50 patients who had received an average total dose of steroids of 2,960 mg in the 3-week period after transplantation, 16 developed AVN.…”

Section: Discussionmentioning

confidence: 99%

“…AVN is a major postoperative complication that develops within 12 weeks (Kubo et al 1997, Fujioka et al 2001 with a reported incidence of 3-40% (Harrington et al 1971, Gustafsson et al 1976, Ibels et al 1978, Anderson and Nielsen 1981, Bradford et al 1983, Julian et al 1992, Tang et al 2000. It has been shown that the total dose in a 1-year period or average daily dose of steroids is related to the risk of development of AVN (Harrington et al 1971, Pierides et al 1975, Chatterjee et al 1976, Patton and Plaff 1988, Tang et al 2000. However, no studies have been published that have evaluated the relationship between the risk of development of AVN and the total dose of steroids in the early period (Table 1).…”

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Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Shibatani¹,

Fujioka²,

Arai³

et al. 2008

Acta Orthopaedica

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Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head, Acta Orthopaedica, 79:5, 631-636, DOI: 10.1080 Background and purpose It has been suggested that avascular osteonecrosis (AVN) of the femoral head develops early after renal transplantation. We evaluated the relationship between risk of AVN and dose of steroids administered in different time periods.Methods Development of AVN was determined using MRI at 3-6 weeks, 9-12 weeks, 24 weeks, and 12 months after transplantation in 150 patients (96 males). We investigated possible associations between acute rejection reactions, the dose of cyclosporine, tacrolimus use, total steroid dose by the second, fourth, sixth, or eighth weeks after transplantation, and incidence of AVN.Results There was no statistically significant difference between incidence of AVN and presence or absence of an acute rejection reaction. We found a statistically significant association between AVN incidence and the total dose of steroids administered during the first 2 months after transplantation, and there was a doseresponse relationship. No other statistically significant associations were found.Interpretation Our findings confirm that the total dose of steroids given within the first 2 months after renal transplantation has a great influence on the incidence of AVN.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Shibatani¹,

Fujioka²,

Arai³

et al. 2008

Acta Orthopaedica

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“…10 Therefore, avascular necrosis is a well-described complication after renal and cardiac transplantation, especially in patients receiving high-dose steroids for graft rejection. [10][11][12][13][14][15][16][17] In 1987, Atkinson et al 18 first described a 10% incidence of osteonecrosis after allogeneic bone marrow transplantation from HLA-identical sibling donors. Since then, few studies have addressed this late complication.…”

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confidence: 99%

Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

Wiesmann

Pereira

Böhm

et al. 1998

Bone Marrow Transplant

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Summary:With improvement in long-term survival after allogeneic stem cell transplantation, late complications with significant morbidity are of increasing importance. We retrospectively analysed 272 recipients of an allogeneic stem cell transplant for the development of osteonecrosis. The incidence among allograft recipients was 6.3% (17/272) for the whole patient population, and 11.8% (17/144) for long-term survivors. All patients were treated with high-dose prednisolone, 16 for severe acute or extensive chronic graft-versus-host disease (GVHD) and one patient for graft rejection. The mean age at time of diagnosis was 33 years (range 16-45) and the mean time from transplant to diagnosis of osteonecrosis was 13 months. Osteonecrosis was diagnosed by magnetic resonance (MR) imaging, which allows early detection of osteonecrosis and assessment of stage. At the time of diagnosis, eight patients had stage I, three patients stage II, three patients stage III and three patients stage IV osteonecrosis according to MR criteria. All but one patient had involvement of the femoral head. The median total dosage of prednisolone at the time of diagnosis was 189 mg/kg (single manifestation 150 mg/kg; multiple manifestations 313 mg/kg) with a total range of 13-555 mg/kg. Six patients were treated by conservative means, 77 patients underwent surgery (three core decompression, eight joint replacement). MR screening of patients receiving highdose steroids might help to detect osteonecrosis at an early stage and thus prevent progression by early intervention, for example, by core decompression. Keywords: avascular necrosis; allogeneic stem cell transplantation; magnetic resonance-steroids With improvement in long-term survival after allogeneic bone marrow transplantation, late complications with significant morbidity are of increasing importance.Osteonecrosis is a general term applied to conditions resulting in necrosis of bone and marrow elements. Avascular necrosis indicates involvement of the epiphysis or subCorrespondence: Dr H Einsele, Department of Hematology and Oncology, University of Tübingen, Otfried Müller Str. 10, 72076 Tübingen, Germany Received 9 March 1998; accepted 20 April 1998 chondral bone, whereas osteonecrosis of the metaphyseal or diaphyseal bone is commonly referred to as bone infarct.

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“…Steroid-induced osteoporosis (Editorial 1972, Solomon 1973, secondary hyperparathyroidism (Arfi et al 1975, Chatterjee et al 1976, ischemia of bone due to fat embolisms (Evarts 8c Phalen 1971) and vascular changes of other etiologies (Harrington et al 1971) have been suggested.…”

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confidence: 99%

Osteonecrosis and Spontaneous Fractures Following Renal Transplantation: A Longitudinal Study of Radiological Bone Changes and Metacarpal Bone Mass

Andresen

Nielsen

1981

Acta Orthopaedica Scandinavica

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Avascular Necrosis of Bone after Renal Transplantation

Cited by 152 publications

References 0 publications

Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Avascular necrosis of bone following allogeneic stem cell transplantation: MR screening and therapeutic options

Osteonecrosis and Spontaneous Fractures Following Renal Transplantation: A Longitudinal Study of Radiological Bone Changes and Metacarpal Bone Mass

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