Pancreas–kidney transplantation is associated with reduced fracture risk compared with kidney-alone transplantation in men with type 1 diabetes

Abstract

Both type 1 diabetes mellitus and end stage renal disease are associated with increased fracture risk, likely due to metabolic abnormalities that reduce bone strength. Simultaneous pancreas-kidney transplantation is a treatment of choice for patients with both disorders, yet the effects of simultaneous pancreas-kidney versus kidney transplantation alone on post-transplantation fracture risk are unknown. From the United States Renal Data System we identified 11, 145 adults with type 1 diabetes undergoing transplantation of whom 4,933 had a simultaneous pancreas-kidney while 6, 212 had a kidney alone transplant between 2000 and 2006. Post-transplantation fractures resulting in hospitalization were identified from discharge codes. Time to first fracture was modeled and propensity score adjustment was used to balance covariates between groups. Fractures occurred in significantly fewer (4.7%) of pancreas-kidney compared to kidney-alone transplant (5.9%) cohorts. After gender stratification and adjustment for fracture covariates, pancreas-kidney transplantation was associated with a significant 31% reduction in fracture risk in men (hazard risk 0.69). Older age, white race, prior dialysis and pre transplantation fracture were also associated with increased fracture risk. Prospective studies are needed to determine the gender-specific mechanisms by which pancreas-kidney transplantation reduces fracture risk in men.

Bone Disease after Kidney Transplantation

“…Outcomes for kidney transplant recipients who sustain a fracture are significantly worse, with a 60% increased risk in mortality compared with the general population (6). The US Renal Data System (USRDS) data show the importance of diabetes, with the risk of fracture among men with diabetes who underwent kidney-only transplantation being 31% higher than those who had received a simultaneous kidney-pancreas transplant (8), a finding consistent with recent microindentation studies showing that patients with diabetes have both reduced BMD and bone strength (9).…”

Spine Trabecular Bone Score as an Indicator of Bone Microarchitecture at the Peripheral Skeleton in Kidney Transplant Recipients

“…Hip fracture risk is 34% higher than for patients on dialysis (4), and hip and spine fracture risks are more than four-and 23-fold higher, respectively, than for the general population (6,7). In large epidemiologic cohorts of kidney transplant recipients, peripheral fractures (e.g., ankle, foot, wrist, and arm) make up the majority of fracture types (5,8,9). Although fracture risk screening in kidney transplant recipients has been controversial, the 2016 updates to the Kidney Disease Improving Global Outcomes Guidelines (out for public review) recommend bone density screening for fracture risk classification.…”

Osteoporosis in Organ Transplant Patients

“…This relationship persisted after controlling for several potential confounders, including GC use. However, data suggest that patients with Type 1 diabetes who undergo kidney-pancreas transplants have a lower rate of fractures than those who undergo only kidney transplant; fracture risk was 36% lower in men who had kidney-pancreas transplants, although this relationship was not seen among women [130]. Fractures are reduced in patients who have early corticosteroid withdrawal.…”