Incidence and Risk Factors for Nontraumatic Osteonecrosis of the Femoral Head in Kidney Transplant Recipients: A Comparison of Two Eras (1985–2000 and 2001–2024)
Edward Y. Cheng, Arthur J. Matas, Lee Houachee, Alireza Mirzaei
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Abstract
Background
Historically, osteonecrosis of the femoral head (ONFH) was a major problem following kidney transplantation, occurring in up to 5%–11% of recipients. The development of new immunosuppressive agents permitted steroid minimization protocols, and consequently, the incidence of ONFH has decreased. We studied ONFH trends over four decades and evaluated risk factors in two immunosuppressive eras, pre- and post-2001.
Patients and Methods
Steroid minimization protocols at our center started in 2000. We reviewed records of 1st kidney transplants from January 1985 to May 2024 and compared ONFH incidence and risk factors between the two eras: Era 1 (January 1985–December 31, 2000) and Era 2 (January 2001–May 2024). Cox regression was used to assess for independent factors associated with a higher or lower incidence of ONFH.
Results
ONFH incidence in Era 1 was 7.2%; Era 2, 1.1% (p < 0.001). In Era 1, increased risk was associated with heavier weight (HR: 1.017, 95% CI: 1.010–1.023, p < 0.001) and mTOR inhibitors (HR: 4.258, 95% CI: 1.726–10.506, p = 0.002); and decreased risk with diabetes (HR: 0.362, 95% CI: 0.270-0.486, p < 0.001), and statins (HR: 0.452, 95% CI: 0.327–0.625, p < 0.001). In Era 2, increased risk was associated with steroid use (HR: 2.096, 95% CI: 1.071–4.100, p = 0.031) and decreased risk with mycophenolate (HR: 0.471, 95% CI: 0.237–0.935, p = 0.032).
Conclusion
The incidence of ONFH in KTRs has dramatically decreased in the modern immunosuppressive era. Diabetes, statin use, and immunosuppressive medications, specifically mTOR inhibitors and mycophenolate, appear to have varying impacts depending on the immunosuppressive era.
期刊介绍:
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.