Long-Term Follow-up of Bone Mass after Orthotopic Liver Transplantation: Effect of Steroid Withdrawal from the Immunosuppressive Regimen

íG, Mart; Gómez, R; Jódar, Esteban; Loinaz, Carmelo; Moreno, Enrique; Hawkins, Edith P.

doi:10.1007/s001980200006

Cited by 25 publications

(2 citation statements)

References 17 publications

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“…This response may be related to the administration of calcium and vitamin D3 itself, but also to improvement in general health, mobility, muscle mass and nutrition as a consequence of better liver function. Furthermore, we have previously reported that steroid withdrawal in LT accelerates the recovery of lumbar spine bone density in patients who have undergone a successful LT [27].…”

Section: Discussionmentioning

confidence: 99%

Effect of early risedronate treatment on bone mineral density and bone turnover markers after liver transplantation: a prospective single-center study

Guadalix

Díaz-Guerra

Lora

et al. 2011

Transplant International

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Summary The aim of this study was to investigate the effect of risedronate (RIS) on bone loss and bone turnover markers after liver transplantation (LT). Patients with osteopenia or osteoporosis within the first month after LT were randomized to receive RIS 35 mg/week plus calcium 1000 mg/day and vitamin D3 800 IU/day (n = 45) or calcium and vitamin D3 at same dosages (n = 44). Primary endpoint was change in bone mineral density (BMD) 6 and 12 months after LT. Secondary endpoints included changes in serum β‐CrossLaps (β‐CTX) and procollagen type 1 amino‐terminal peptide (P1NP) and fracture rate. Spine X‐rays were obtained at baseline and after 12 months. There was no significant difference in BMD changes between both treatment groups at any sites; either at 6 or 12 months. Spine BMD increased in both groups at 12 months vs. baseline (P = 0.001). RIS patients had a significant increase in intertrochanteric BMD at 12 months (P < 0.05 vs. baseline). Serum β‐CTX decreased in both groups (P < 0.01), with significant differences between groups at 3 months. No significant difference in vertebral fracture incidence was found. After 12 months, BMD improved at lumbar spine and did not change at hip in both groups. Significant differences between both groups were not found. Other factors (calcium and vitamin D replacement, early prednisone withdrawal) seem to have also positive effects in BMD.

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Section: Discussionmentioning

confidence: 99%

Effect of early risedronate treatment on bone mineral density and bone turnover markers after liver transplantation: a prospective single-center study

Guadalix

Díaz-Guerra

Lora

et al. 2011

Transplant International

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“…Given the numerous adverse effects of steroids, steroid reduction, withdrawal, and complete avoidance have been considered by many pediatric (17, 19, 187–192) and adult (193–201) transplantation centers while assessing the effect on rejection and overall outcomes. While not the subject of this review, results have generally suggested reasonable success rates among selected heart and liver recipients, while studies in kidney transplantation have had at least one prominent negative finding and review (193, 195).…”

Section: Management Strategiesmentioning

confidence: 99%

Osseous complications of pediatric transplantation

Saland

2004

Pediatric Transplantation

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Adult stature and peak bone mass are achieved through childhood growth and development. Multiple factors impair this process in children undergoing solid organ transplantation, including chronic illness, pretransplant osteodystrophy, use of medications with negative impact on bone, and post-transplant renal dysfunction. While growth delay and short stature remain common, the most severe forms of transplant-related bone disease, fracture and avascular necrosis, appear to have become less common in the pediatric age group. Osteopenia is very prevalent in adult transplant recipients and probably also in pediatrics, but its occurrence and sequelae are difficult to study in these groups due to methodological shortfalls of planar densitometry related to short stature and altered patterns of growth and development. Although the effect on lifetime peak bone mass is not clear, data from adult populations suggest an elevated long-term risk of bone disease in children receiving transplants. Optimal management of pretransplantation osteodystrophy, attention to post-transplant renal insufficiency among both renal and non-renal transplant patients, reduction of steroid dose in select patients, and supplementation with calcium plus vitamin D during expected periods of maximal bone loss may improve bone health. Careful research is required to determine the role of bisphosphonate therapy in pediatric transplantation.

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Longitudinal Changes in BMD and Fracture Risk in Orthotopic Liver Transplant Recipients Not Using Bone-Modifying Treatment

Dekkers

Kroon

et al. 2014

Journal of Bone and Mineral Research

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Osteoporosis is prevalent in end-stage liver disease, but data on long-term changes in bone mineral density (BMD) and related fracture incidence after orthotopic liver transplantation (OLT) are scarce. We evaluated BMD changes up to 5 years in consecutive recipients of a successful OLT at the Leiden University Medical Centre between 2000 and 2011, in whom sequential BMD data were available. Spinal radiographs were available at time of screening and at 6 and 12 months post-OLT and were assessed for vertebral fractures by two independent observers using Genant's semiquantitative method. Patients were excluded from the study when started on bisphosphonates. A total of 201 patients (71% men), median age 53 years (range, 18-70 years) were included in the study. Most common liver pathology was viral (27%) or alcoholic liver disease (25%). All patients received prednisone for at least 6 months after transplantation and the majority received either tacrolimus or cyclosporine for immunosuppression. At time of screening for OLT, osteoporosis and osteopenia were found in 18% and 36% of patients at the lumbar spine (LS), respectively, and in 9% and 42% at the femoral neck (FN), respectively. T-scores declined significantly at both sites 6 months after OLT, but increased thereafter at the LS, reaching pretransplantation values at 2 years and remaining stable thereafter. FN T-scores remained consistently lower than pretransplantation values. The prevalence of vertebral fractures increased from 56% at screening to 71% at 1 year after OLT, with a fracture incidence of 34%. BMD changes did not predict fracture risk. Osteoporosis, osteopenia, and vertebral fractures are prevalent in patients with end-stage liver disease. An overall decline in BMD is observed within the first 6 months after OLT, with subsequent recovery to pretransplantation values at the LS, but not at the FN. Vertebral fracture risk is high after OLT regardless of changes in BMD.

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Long-Term Follow-up of Bone Mass after Orthotopic Liver Transplantation: Effect of Steroid Withdrawal from the Immunosuppressive Regimen

Cited by 25 publications

References 17 publications

Effect of early risedronate treatment on bone mineral density and bone turnover markers after liver transplantation: a prospective single-center study

Effect of early risedronate treatment on bone mineral density and bone turnover markers after liver transplantation: a prospective single-center study

Osseous complications of pediatric transplantation

Longitudinal Changes in BMD and Fracture Risk in Orthotopic Liver Transplant Recipients Not Using Bone-Modifying Treatment

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