RESUMEN
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.
Asunto(s)
Necrosis de la Cabeza Femoral/etiología , Glucocorticoides/administración & dosificación , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Ciclosporina/administración & dosificación , Ciclosporina/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Necrosis de la Cabeza Femoral/inducido químicamente , Glucocorticoides/efectos adversos , Rechazo de Injerto , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/efectos adversos , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Prednisolona/administración & dosificación , Prednisolona/efectos adversos , Factores de Riesgo , Tacrolimus/administración & dosificación , Tacrolimus/efectos adversos , Factores de TiempoRESUMEN
We investigated risk factors for osteonecrosis of the femoral head (ONF) in renal transplant recipients, who are susceptible to the disease. Among 287 renal transplant recipients, 18 ONF patients with enough data were included, and 18 age- and sex-matched recipients without ONF were nominated as reference cases. Risk factors were analyzed using a conditional logistic regression method. There were no differences between the ONF patients and the reference cases regarding the types of immunosuppressant or the donor (living or cadaveric, father or mother, matching blood type and human leukocyte antigens). The daily oral steroid dosage (prednisolone 25.0 mg/day or more) and blood urea nitrogen level 2 months after transplantation were the only factors with relevance to the occurrence of ONF. We propose that oral steroid dosages should be low or reduced after renal transplantation, and acute rejection should be controlled with pulsed therapy.