Avascular Necrosis following Renal Transplantation

Lee, Dong Hee; Kim, Song Cheol; Han, Duck Jong; Kim, Suk Ku; Lee, Soo Ho; Jang, Jae Suk

Abstract

Between Jan. 1990 and Sep. 1996, 462 renal allografts were carried out at the Ulsan University College of Medicine and Asan Medical Center. This study was undertaken to evaluate a clinicopathologic features, to document a relationship between dosage and duration of the corticosteroids, and to figure out a treatment strategy of avascular necrosis(AVN) of bone in 13 cases of AVN of the femoral head following renal transplantation. A control group of 15 cases were randomly selected among 462 cases of renal allografts to do a comparative study with 13 cases of AVN. The diagnosis of AVN of bone was made on the basis of plain radiographs and MRI or bone scan. 1) The incidence of AVN was 2.8%(13/462). 2) In entire cases, affected site of bone was the femoral head. The main clinical manifestations were hip joint pain, limitation of weight bearing and motion. The mean onset of first bone symptoms of AVN was 5.5 months(1~9 months). 3) Clinical parameters such as age, sex, type and duration of preoperative dialysis, type of donor, rate of body weight change, and duration of follow up had no relation with the prevalence of AVN. 4) The mean total doses of corticosteroids at 1, 3, 6, and 12months post-transplantation were not differ significantly between the two groups. 5) Biochemical parameters, such as BUN/Cr., Ca, /P, /ALP., AST/ALT, cholesterol, glucose, total protein, and albumin had no relation save the preoperative BUN, total protein. 6) The mean duration of diagnosis of this condition were 12.9 months(range, 9~31 months), 6.7 months(range, 1~12 months), 6.9 months(range, 1~14 months) by X-ray, MRI, and bone scan respectively. 4/12(33.3%) cases of AVN was diagnosed by magnetic resonance imaging(MRI) at the time of the first clinical bone symptoms. 7) In AVN group, conservative management were performed in 2 cases, core decompression in 7 cases, and total hip replacement arthroplasty(THRA) were performed in 4 cases of AVN of the femoral head. From this study, we could not illustrate the precipitating factors in transplant recipients using steroid following renal transplantation. We considered that prognosis of AVN depends entirely on early diagnosis using MRI or bone scan, and proper treatment according to the stage of this condition.