SUN-344 AVASCULAR NECROSIS IN KIDNEY TRANSPLANT RECIPIENTS

Abstract

Avascular osteonecrosis (AVN) remains the most widely recognized osseous complication following renal transplantation (RT) due to bone disorder, steroid use and common comorbidities. The improvement of immunosuppressive treatments has undoubtedly allowed a significant reduction in its prevalence (from 37% in 1968 to 4% in these days). However, knowledge on risk factors and outcomes of AVN among kidney transplant recipients (KTR) in the modern era of immunosuppression remains scarce. We performed a retrospective descriptive study in 212 patients transplanted successfully in our center between 1995 and September 2018. Median follow-up after RT was 58 months. The data collected was analyzed to evaluate the frequency of AVN among our KTR, to determine the risk factors for its occurrence and the management therapy Among the 212 patients only 4 presented an AVN. All of them had undergoing living-donor RT, a prevalence of 1.88 %, with male predominance (3 men and 1 woman). The age at diagnosis (symptoms onset) range from 27 to 64 years. The first painful symptoms occurred respectively after 4, 11, 15 and 132 months of the transplant with recourse to X-ray exam and magnetic resonance imaging mostly for diagnosis. The femoral head was the preponderant site (3 cases) and no one had several localizations from the start. 3 of KTRs had bilateral AVN and 3 showed AVN on the allograft side. The main risk factors are: obesity (25 %) or dyslipidemia (50 %), the average cumulative dose of corticosteroids over the 12 months following transplantation (7.2 g eq 19.7 mg / day of prednisone), delayed functioning of the graft (75 %) and acute rejection (75%). There does not appear to be any participation of bone mineral disorders profile or phosphocalcic abnormalities as other potential risk factors. Totally, 4 patients were conservatively managed with reduction of steroid doses with no recourse to total hip arthroplasty This study shows that high dose of steroid required in acute rejection, dyslipidemia and overweight are the main current risk factors for AVN development. The reduction or early withdrawal of steroids combined with management of dyslipidemia and an optimal body mass index (BMI) were effective preventive strategies to avoid AVN.