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)

IF 1.9 4区 医学 Q2 SURGERY
Edward Y. Cheng, Arthur J. Matas, Lee Houachee, Alireza Mirzaei
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引用次数: 0

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.

肾移植受者非外伤性股骨头坏死的发生率及危险因素:两个时期(1985-2000和2001-2024)的比较
历史上,股骨头坏死(ONFH)是肾移植后的主要问题,发生率高达5%-11%。新的免疫抑制剂的发展允许类固醇最小化方案,因此,ONFH的发病率已经下降。我们研究了40年来ONFH的趋势,并评估了2001年前和2001年后两个免疫抑制时期的危险因素。患者和方法本中心的类固醇最小化方案始于2000年。我们回顾了1985年1月至2024年5月的第一次肾移植记录,并比较了两个时代的ONFH发病率和危险因素:第一时代(1985年1月至2000年12月31日)和第二时代(2001年1月至2024年5月)。Cox回归用于评估与ONFH发病率高低相关的独立因素。结果1期ONFH发病率为7.2%;Era 2, 1.1% (p <;0.001)。在第1期,风险增加与体重增加相关(HR: 1.017, 95% CI: 1.010-1.023, p <;0.001)和mTOR抑制剂(HR: 4.258, 95% CI: 1.726-10.506, p = 0.002);患糖尿病的风险降低(HR: 0.362, 95% CI: 0.270-0.486, p <;0.001),他汀类药物(HR: 0.452, 95% CI: 0.327-0.625, p <;0.001)。在第2时代,使用类固醇增加风险(HR: 2.096, 95% CI: 1.071-4.100, p = 0.031),使用霉酚酸酯降低风险(HR: 0.471, 95% CI: 0.237-0.935, p = 0.032)。结论在现代免疫抑制时代,KTRs中ONFH的发生率显著降低。糖尿病、他汀类药物的使用和免疫抑制药物,特别是mTOR抑制剂和霉酚酸盐,似乎有不同的影响,取决于免疫抑制的时代。
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来源期刊
Clinical Transplantation
Clinical Transplantation 医学-外科
CiteScore
3.70
自引率
4.80%
发文量
286
审稿时长
2 months
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.
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