J Korean Soc Transplant.  2017 Dec;31(4):200-206. 10.4285/jkstn.2017.31.4.200.

Predictors of Avascular Necrosis after Kidney Transplantation

• Ko YM
• Kwon H
• Chun SJ
• Kim YH
• Choi JY
• Shin S
• Jung JH
• Park SK
• Han DJ

• KMID: 2401571
• DOI: http://doi.org/10.4285/jkstn.2017.31.4.200

Abstract

BACKGROUND
Risk factors for bone avascular necrosis (AVN), a common late complication after kidney transplantation (KT), are not well known.
METHODS
Patients that underwent living-donor KT at Asan Medical Center between January 2009 and July 2016 were included in this retrospective study to determine the incidence and risk factors for AVN after KT.
RESULTS
Among 1,570 patients that underwent living-donor KT, 33 (2.1%) developed AVN during a mean follow-up of 49.8±25.0months. Additionally, AVN was diagnosed at a mean of 13.9±6.6 months after KT. The mean cumulative corticosteroid dose during the last follow-up in patients without AVN (9,108±3,400 mg) was higher than that that in patients with AVN (4,483±1,114 mg) until AVN development (P < 0.01). More patients among those with AVN (n=4, 12.1%) underwent steroid pulse treatment because of biopsy-proven rejections during the first 6 months after KT than patients without AVN (n=68, 4.4%; P=0.04). Female (hazard ratio [HR], 2.29; P=0.04) and steroid pulse treatment during the first 6 months (HR, 2.31; P=0.02) were significant AVN risk factors as revealed by the Cox proportional multivariate analysis. However, no significant differences in rejection-free graft survival rates were observed between the two groups (P=0.67).
CONCLUSIONS
Steroid pulse treatment within 6 months of KT and being female were independent risk factors for AVN development.

Keyword

Osteonecrosis; Kidney transplantation; Female; Immunosuppression

MeSH Terms

Chungcheongnam-do
Female
Follow-Up Studies
Graft Survival
Humans
Immunosuppression
Incidence
Kidney Transplantation*
Kidney*
Multivariate Analysis
Necrosis*
Osteonecrosis
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Incidence of avascular necrosis after kidney transplantation.

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  Fig. 2 Kaplan-Meier curves for rejection-free survival stratified according to avascular necrosis (AVN) development.

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