Abstract
Aseptic necrosis (AN) of bone was evaluated in 19 renal transplant (Tx) patients (ages 3-17 yrs.). Two were excluded because of early death. The average time from recognition of renal failure to Tx in the remaininq 17 patients (6M; 11F) was 26 mos. Four had minimal X-ray evidence of hyoerparathyroidism prior to Tx but none of the 17 had a parathyroidectomy nor received vitamin D or calcium before or after Tx. With post-Tx follow-up of 6-28 mos., 6 of 17 (35%) had symptoms and X-ray findings of AN. The average duration between Tx and onset of symptoms and positive X-ray findings was 5.5 mos. and 7.6 mos. respectively (range 1-15 mos.). All patients had involvement of 2 or 3 weight bearing joints. Presence of AN was related to duration of recognized renal failure before Tx (p<.001). The average aae at Tx in those with AN was 14.5 yrs., while in those without AN was 11.5 yrs. (p<0.05). Five patients, never receiving a high dose I.V. methylprednisolone (MP) “pulse” for rejection, had no AN; 6 of 12 who were “pulsed” developed AN (p/0.07). The following were found not to be correlated with AN: previous hyperparathyroidism, time on dialysis, prednisone before Tx (4 pts.), or total dosage of prednisone post-Tx. AN has been the major morbidity in this Tx population. Evidence suggests that AN in children is related to the duration of uremia, development of puberty, and to the number of IV MP “pulses”, but not total dosage of steroids.
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