Elsevier

Transplantation Proceedings

Volume 39, Issue 10, December 2007, Pages 3153-3158
Transplantation Proceedings

Kidney transplantation
Complication: Cardiovascular and metabolic
Renal Osteodystrophy After Successful Renal Transplantation: A Histomorphometric Analysis in 57 Patients

https://doi.org/10.1016/j.transproceed.2007.10.001Get rights and content

Abstract

Renal transplantation is the treatment of choice for patients with end-stage renal disease. It corrects most of the metabolic abnormalities that cause renal osteodystrophy. Nevertheless, renal osteodystrophy persists in many transplant recipients. The aim of this study was to investigate frequency and histomorphometric pattern of bone disease after renal transplantation. Bone biopsy specimens were taken from the iliac crest of 57 patients, including 28 women (26–70 years old) and 29 men (27–67 years old). Indications for biopsy were hypercalcemia, elevation of parathyroid hormone, and, in 19 cases, without suspected bone abnormalities based on laboratory parameters. The mean time of dialysis prior to renal transplantation was 43 months (range, 6–91 months in women and 10–111 months in men) and the mean interval between transplantation and bone biopsy was 53.5 months (range, 4–191 months in women and 5–90 months in men). Fourteen patients were treated with either 25-hydroxyvitamin D3 and/or 1-α hydroxyvitamin D3 or 1,25 dihydroxyvitamin D3, 3 with phosphate-binding agents. The immunosuppression consisted of cyclosporine, azathioprine, and prednisolone. The cumulative dosage of corticosteroids was 5569 ± 5305 mg. For static and dynamic histomorphometry, we used American Society of Bone and Mineral Research nomenclature. Mild osteitis fibrosa and osteitis fibrosa, the most frequent forms of renal osteodystrophy, were observed in 13. (22.8%) and 14 patients (24.6%), respectively. Mixed uremic osteodystrophy was found in 7 patients (12.3%), adynamic renal bone disease in 3 patients (5.3%), and osteomalacia in 2 patients (3.5%). In 13 patients (22.8%), reduced bone mass and structural damage without typical signs of renal osteodystrophy, such as endosteal fibrosis or osteoclasia, were detected, and 5 patients (8.7%) showed normal histomorphometric parameters. We concluded that renal osteodystrophy, especially forms with high bone turnover, persisted in many patients after successful renal transplantation. This finding may be due to preexisting conditions, such as duration of dialysis and degree of hyperparathyroidism. Bone disease is increased by corticosteroid and immunosuppressive therapy after renal transplantation and requires close monitoring.

Section snippets

Patients and Methods

This study was performed retrospectively on a cohort of 57 patients who underwent bone biopsy at various intervals after successful renal transplantation. The study was approved by the local university committee; patients provided informed consent. Indications for performing bone biopsy were as follows: persistent elevations of parathyroid hormone (PTH) levels in 12 cases; hypercalcemia in 7 cases; and 19 patients with second biopsy to detect transformation of ROD forms. In addition we included

Clinical Data and Laboratory Parameters

Available clinical data, including duration of dialysis prior to renal transplantation, interval between transplantation and bone biopsy, and cumulative prednisolone intake are shown in Table 2. Because the interval between bone biopsy and transplantation varied, there was a wide range of cumulative prednisolone doses. Highest doses of prednisolone were observed in patients with osteitis fibrosa and non–ROD. For patients with mild osteitis fibrosa and normal histological pattern, these

Discussion

This study was performed to investigate the histomorphometric forms of ROD after renal transplantation. Despite restoration of kidney function, patients developed various histological abnormalities. Our results agree with previous studies that demonstrated the variability of histological abnormalities of bone after transplantation.1, 2, 3, 4

In contrast to other organ transplant recipients patients with chronic renal failure develop ROD prior to kidney transplantation.13, 14, 15 Their form and

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