The Characteristics And Risk Factors Of Osteonecrosis Of Femoral Head After Renal Transplantation

Objective:To investigate the incidence,clinical characteristics,relationship with glucocorticoid and the risk factors of osteonecrosis of femoral head( ONFH) after kidney transplantation.Materials and methods: we studied 203 patients who underwent kidney transplantation in Tian jin First Central Hospital from January 2009 to June 2012,which were not osteonecrosis of femoral head before operation.According to the diagnostic criteria,they are divided into two Groups.Put the 11 patients with ONFH into the case groups.Put the remaining 192 patients without ONFH into the control group.Analyze the clinical characteristics including age、gender, nationality, height, weight, occupation, the time osteonecrosis occurred from kidney transplant, single or double side osteonecrosis of femoral head and other features. At the same time, through comparing the differences between the two groups of the total doses of pulse glucocorticoid and the cumulative doses of oral glucocorticoid one month、two month、three month、six month after renal transplantation, we study the relationship between the ONFH and the cumulative doses of oral and pulse glucocorticoid and the use way of glucocorticoid after renal transplantation. In addition, analyze all variables that may be related to the development of ONFH after kidney transplantation,including age, sex, weight, height, BMI, and basic diseases, smoking,drinking, primary disease, types of dialysis, dialysis time, kidney resource, kidney warm ischemia time, kidney cold ischemia time,immunodepressant,acute rejection, weight gain 1 year after operation, the blood urea nitrogen level、the creatinine level、blood calcium levels、blood phosphorus levels、alkaline phosphatase level before and after renal transplantation.Results: 1. After renal transplantation,11 cases occurred ONFH in the 203 patients, the incidence of ONFH was 5.4%.2. In the 11 patients with ONFH,the minimum age is 35 years old, the maximum age is 56 years old, average age is 46.5 years old. There is Five men and six women.The lowest weight is 45 Kg, the highest weight is 82 Kg, the average weight is 62.5 Kg. The highest height is 181 cm, the minimum height is 159 cm, with an average of 169.1 cm. People are all the han nationality. The 11 patients, profession are one driver,one police, one doctor, three farmers, five jobless.The ONFH occurred at a mean of 7.7 months after renal transplantation(rang,2-24months). There is 10 patients with bilateral femoral head necrosis and 1 patient with unilateral femoral head necrosis.3. In case group,the mean cumulative doses of oral prednisolone is 73 8.64±162.93 mg 1 month after renal transplantation with 633.29 ± 181.79 mg in control group,but there is no statistical differences between the two group(P>0.05).In case group, the mean cumulative doses of oral prednisolone is 118 0.45±164.67 mg 2 month after renal transplantation with 1082.40±180.33 mg in control group,but there is no statistical differences between the two group(P>0.05).In case group, the mean cumulative doses of oral prednisolone is 146 1.36±138.37 mg 3 month after renal transplantation with 1378.03±160.95 mg in control group,but there is no statistical differences between the two group(P>0.05).In case group, the mean cumulative doses of oral prednisolone is 2370.45±163.18 mg 6 month after renal transplantation with 2272.35±169.42 mg in control group,but there is no statistical differences between the two group(P>0.05).In case group,the tatol cumulative does of pulse methylprednisolone is 5125.45±1157.49 mg after renal transplantation with 3470.73±779.61 mg in control group,but there is obvious statistical differences between the two group(P<0.05).4. There is significantly statistical differences in age、dialysis time before kidney transplantation、acute rejection、first year posttransplant body weight gain between case group and control group.Conclusion: 1.The incidence of femoral head necrosis after kidney transplantation is 5.4% and similar to that reported in literatures.2.The average age in case group is older than control group.But there is no significantly statistical differences in gender, height, weight and occupation. The earliest time of avascular necrosis can be two months after renal transplantation with an average of 7.7 months. Bilateral osteonecrosis of femoral head is common in the patients after renal transplantation.3.The cumulative doses of oral prednisolone is no obvious correlation with femoral head necrosis after renal transplantation. The excessive tatol cumulative does of pulse methylprednisolone is a major cause of osteonecrosis of femoral head after renal transplantation.4.The older age when transplantation, long dialysis, acute rejection using intravenous pulse, weight gain 1 year after operation are risk factors for osteonecrosis of femoral head after renal transplantation.