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

• Published in: Acta orthopaedica 2008-01, Vol.79 (5), p.631-636
• Main Authors: Shibatani, Masahiko, Fujioka, Mikihiro, Arai, Yuji, Takahashi, Kenji, Ueshima, Keiichiro, Okamoto, Masahiko, Yoshimura, Norio, Hirota, Yoshio, Fukushima, Wakaba, Kubo, Toshikazu
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Diseases of the osteoarticular system; Dose-Response Relationship, Drug; Female; Femur Head Necrosis - chemically induced; Femur Head Necrosis - etiology; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Graft Rejection; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Kidney Transplantation - adverse effects; Male; Medical sciences; Methylprednisolone - administration & dosage; Methylprednisolone - adverse effects; Pharmacology. Drug treatments; Postoperative Complications - chemically induced; Postoperative Complications - etiology; Prednisolone - administration & dosage; Prednisolone - adverse effects; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tacrolimus - administration & dosage; Tacrolimus - adverse effects; Time Factors; Vascular bone diseases
• ISSN: 1745-3674; 1745-3682
• DOI: 10.1080/17453670810016641

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.