Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study

Abstract

Background

There is a lack of evidence about the risk factors associated with osteonecrosis of the femoral head (ONFH).

Purposes

To determine the incidence and risk factors for ONFH following renal transplantation (RT).

Methods

In total, data of 681 RT patients (mean age at surgery, 49.5 ± 13.6 years; 249 women and 432 men) were evaluated to determine the incidence of ONFH. Hip magnetic resonance imaging (MRI) was performed six months after RT. The following potential predictors of ONFH were evaluated: (1) patient’s condition at RT; laboratory test results including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone before RT; blood relationship between the patient and donor; and mismatching number of human leukocyte antigens (HLAs), especially HLA class I and class II and (2) dosages of steroids after RT, immunosuppressive regimen, and incidence of acute rejection.

Results

ONFH was observed in 30 hips (21 cases, 3.1%). We successfully matched 63 patients without ONFH. Multivariate logistic regression analysis, adjusted for cumulative dosages of steroids, revealed that mismatching number of HLA (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10–2.36; p = 0.014), HLA class II (HR, 3.73; 95% CI, 1.46–9.56; p = 0.001), P before RT (HR, 1.62; 95% CI, 1.02–2.58; p = 0.041), and Ca × P  before RT (HR, 1.06; 95% CI, 1.01–1.11; p = 0.024) were risk factors for ONFH.

Conclusion

A greater number of HLA mismatches, HLA class II, serum P, and serum Ca × P were risk factors for ONFH after RT. Therefore, these factors should be evaluated in order to predict ONFH after RT.

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References

  1. 1.

    Takao M, Sakai T, Nishii T et al (2011) Incidence and predictors of osteonecrosis among cyclosporin- or tacrolimus-treated renal allograft recipients. Rheumatol Int 31:165–170. https://doi.org/10.1007/s00296-009-1241-8

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Sakai T, Sugano N, Kokado Y et al (2003) Tacrolimus may be associated with lower osteonecrosis rates after renal transplantation. Clin Orthop Relat Res:163–170. https://doi.org/10.1097/01.blo.0000093908.26658.df

  3. 3.

    Ohtsuru T, Yamamoto T, Murata Y et al (2019) Incidence of osteonecrosis and insufficiency fracture of the hip and knee joints based on MRI in 300 renal transplant patients. Hip Int 29:316–321. https://doi.org/10.1177/1120700018808693

    Article  PubMed  Google Scholar 

  4. 4.

    Lopez-Ben R, Mikuls TR, Moore DS et al (2004) Incidence of hip osteonecrosis among renal transplantation recipients: a prospective study. Clin Radiol 59:431–438. https://doi.org/10.1016/j.crad.2003.11.001

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Kubo T, Fujioka M, Yamazoe S et al (1998) Relationship between steroid dosage and osteonecrosis of the femoral head after renal transplantation as measured by magnetic resonance imaging. Transplant Proc 30:3039–3040. https://doi.org/10.1016/s0041-1345(98)00920-8

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Takao M, Abe H, Sakai T et al (2020) Transitional changes in the incidence of hip osteonecrosis among renal transplant recipients. J Orthop Sci 25(3):466–471. https://doi.org/10.1016/j.jos.2019.06.009

  7. 7.

    Saito M, Ueshima K, Fujioka M et al (2014) Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis. Acta Orthop 85:266–270. https://doi.org/10.3109/17453674.2014.916490

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Landmann J, Renner N, Gächter A et al (1987) Cyclosporin A and osteonecrosis of the femoral head. J Bone Joint Surg Am 69:1226–1228

    CAS  Article  Google Scholar 

  9. 9.

    Tang S, Chan TM, Lui SL et al (2000) Risk factors for avascular bone necrosis after renal transplantation. Transplant Proc 32:1873–1875. https://doi.org/10.1016/s0041-1345(00)01471-8

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Inoue S, Horii M, Asano T et al (2003) Risk factors for nontraumatic osteonecrosis of the femoral head after renal transplantation. J Orthop Sci 8:751–756. https://doi.org/10.1007/s00776-003-0716-9

    Article  PubMed  Google Scholar 

  11. 11.

    Felten R, Perrin P, Caillard S et al (2019) Avascular osteonecrosis in kidney transplant recipients: risk factors in a recent cohort study and evaluation of the role of secondary hyperparathyroidism. PLoS One 14:e0212931. https://doi.org/10.1371/journal.pone.0212931

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Shi X, Lv J, Han W et al (2018) What is the impact of human leukocyte antigen mismatching on graft survival and mortality in renal transplantation? A meta-analysis of 23 cohort studies involving 486,608 recipients. BMC Nephrol 19:116. https://doi.org/10.1186/s12882-018-0908-3

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Opelz G, Döhler B (2012) Association of HLA mismatch with death with a functioning graft after kidney transplantation: a collaborative transplant study report. Am J Transplant 12:3031–3038. https://doi.org/10.1111/j.1600-6143.2012.04226.x

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Sugano N, Atsumi T, Ohzono K et al (2002) The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci 7:601–605. https://doi.org/10.1007/s007760200108

    Article  PubMed  Google Scholar 

  15. 15.

    Opelz G, Döhler B (2007) Effect of human leukocyte antigen compatibility on kidney graft survival: comparative analysis of two decades. Transplantation 84:137–143. https://doi.org/10.1097/01.tp.0000269725.74189.b9

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Boaz M, Weinstein T, Matas Z et al (2005) Peripheral vascular disease and serum phosphorus in hemodialysis: a nested case-control study. Clin Nephrol 63:98–105. https://doi.org/10.5414/CNP63098

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Goldsmith DJA, Covic A, Sambrook PA, Ackrill P (1997) Vascular calcification in long-term haemodialysis patients in a single unit: a retrospective analysis. Nephron 77:37–43. https://doi.org/10.1159/000190244

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Block GA, Port FK (2000) Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney Dis 35:1226–1237. https://doi.org/10.1016/S0272-6386(00)70064-3

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Yamamoto T, Irisa T, Sugioka Y et al (1997) Effects of pulse methylprednisolone on bone and marrow tissues. Corticosteroid-induced osteonecrosis in rabbits. Arthritis Rheum 40:2055–2064. https://doi.org/10.1002/art.1780401119

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Kerachian MA, Séguin C, Harvey EJ (2009) Glucocorticoids in osteonecrosis of the femoral head: a new understanding of the mechanisms of action. J Steroid Biochem Mol Biol 114:121–128. https://doi.org/10.1016/j.jsbmb.2009.02.007

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Kubo T, Yamazoe S, Sugano N et al (1997) Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 15:1017–1023. https://doi.org/10.1016/S0730-725X(97)00159-8

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Yoshitoshi Higuchi.

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Higuchi, Y., Tomosugi, T., Futamura, K. et al. Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study. International Orthopaedics (SICOT) (2020). https://doi.org/10.1007/s00264-020-04668-w

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Keywords

  • Osteonecrosis of the femoral head
  • Renal transplant
  • Risk factor
  • Magnetic resonance imaging