RISK FACTORS INFLUENCING THE DEVELOPMENT OF OSTEONECROSIS AFTER RENAL TRANSPLANTATION

PURPOSE: This study was performed to determine risk factors influencing the development of osteonecrosis after renal transplantation. METHODS:We retrospectively evaluated osteonecrosis in 308 kidney graft recipients (240 living and 68 cadaveric) who were transplanted and followed-up in our transplant unit between 1986-2000. Kidney recipients transplanted after each of the 29 recipients with osteonecrosis (the mean age: 38.8+10.7; female/male ratio: 9/20) were used as controls (the mean age: 30.8+8.6; female/male ratio: 10/19). Both groups were matched to age, gender, duration of chronic renal failure, cumulative time on dialysis, pretransplant steroid therapy, hyperparathyroidism, renal osteodystrophy, osteoporosis, donor source, immunosuppressive therapy, cumulative steroid dose, creatinine clearance and the findings of serum biochemistry. Mann-Whitney U test and Student's t test were used for stastical analysis. RESULTS:The patients with osteonecrosis were significantly older than controls (p=0.003). Pretransplant renal osteodystrophy was determined in six patients in osteonecrosis group and in one patient in control group (p=0.04). Seven patients had pretransplant osteoporosis in osteonecrosis group and none of the patients in control group(p=0.004). Mean serum triglyceride was measured as 184+103 mg/dl in osteonecrosis group and as 138+53 mg/dl in control group (p=0.03). Mean serum albumin was found as 4.2+0.5 g/dl in osteonecrosis group and as 4.5+0.45 g/dl in control group (p=0.01). The other factors were not different between the two groups CONCLUSION:Advanced age, pretransplant renal osteodystrophy and osteoporosis, elevated triglyceride and lower albumin levels 'were found to be risk factors for osteonecrosis in our study.