Avascular Necrosis and Risk Factors in Kidney Transplant Recipients: A Single-Center Experience

Abstract

Objectives: Renal osteodystrophy, osteoporosis, bone fractures, and avascular necrosis (AVN) are prevalent complications observed in the posttransplant period among kidney transplant recipients (KTRs). Despite notable advancements, AVN remains a significant and devastating complication following kidney transplantation (KT). Materials and Methods: The study included all patients who underwent KT at our transplantation unit and had at least one year of routine followup (n=343). Cases of symptomatic AVN were diagnosed by X-radiation, radioisotope bone scan, or magnetic resonance imaging. We evaluated the baseline characteristics, laboratories, and immunosuppressive treatments of KTRs. Results: The frequency of AVN in our KTRs was 7.9% during the follow-up period, with a median diagnosis time of 15.2 (10.2-34.9) months. In KTRs with AVN, the leading cause of end-stage renal disease was glomerulonephritis (GN) (52% vs. 20%, p<0.001), and more rejection episodes occurred at follow-up (33% vs. 15%, p=0.01). In univariate analysis, GN [odds ratio (OR): 4.325, 95% confidence interval (CI), 1.936-9.661], cumulative steroid dosage at the post-transplant first year (OR: 1.001, 95% CI, 1.000-1.002), and rejection episodes (OR: 2.792, 95% CI, 1.185-6.578) detected as possible risk factors for AVN. Upon multivariate analysis, GN was identified as an independent risk factor for the development of AVN (OR: 4.373, 95% CI, 1.935-9.880, p<0.001). Conclusion: Our study found GN to be associated with an increased risk of AVN. A higher prevalence of AVN may attributed to long-term pretransplant steroid therapy in this group. In KTRs with a history of GN, greater awareness should be paid to cumulative steroid dosages, and early discontinuation of steroids may be considered.

Keywords

• Avascular necrosis
• glomerulonephritis
• mineral bone disease
• renal transplantation
• steroid therapy

Avascular Necrosis and Risk Factors in Kidney Transplant Recipients: A Single-Center Experience

Abstract

Amaç: Renal osteodistrofi, osteoporoz, kemik kırıkları ve avasküler nekroz (AVN), böbrek nakli alıcılarında (BNA) transplantasyon sonrası dönemde yaygın komplikasyonlardır. Kaydedilen önemli ilerlemelere rağmen, AVN böbrek nakli (BN) sonrası hala ciddi ve yıkıcı bir komplikasyon olmaya devam etmektedir. Gereç ve Yöntem: Çalışmaya, transplantasyon ünitemizde BN yapılan ve en az bir yıl düzenli takip edilen tüm hastalar (n=343) dahil edildi. Semptomatik AVN vakaları röntgen, radyoizotop kemik taraması veya manyetik rezonans görüntüleme ile teşhis edildi. BNA’ların temel özellikleri, laboratuvar sonuçları ve immünsüpresif tedavileri değerlendirildi. Bulgular: BNA’larda AVN sıklığı %7,9 olup, medyan teşhis süresi 15,2 (10,2-34,9) ay olarak belirlendi. AVN gelişen BNA’larda, son dönem böbrek hastalığının en yaygın nedeni glomerulonefrit (GN) idi (%52’ye karşı %20, p<0,001) ve takip sürecinde daha fazla rejeksiyon epizodu görüldü (%33’e karşı %15, p=0,01). Tek değişkenli analizde GN [olasılık oranı (OR): 4,325; %95 güven aralığı (GA), 1,936-9,661], nakil sonrası ilk yıldaki kümülatif steroid dozu (OR: 1,001; %95 GA, 1,000-1,002) ve rejeksiyon epizodları (OR: 2,792; %95 GA, 1,185-6,578) AVN için olası risk faktörleri olarak saptandı. Çok değişkenli analizde ise GN, AVN gelişimi için bağımsız bir risk faktörü olarak belirlendi (OR: 4,373; %95 GA, 1,935-9,880;

Keywords

• Avascular necrosis
• glomerulonephritis
• mineral bone disease
• renal transplantation
• steroid therapy

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