The introduction of cyclosporine has allowed a reduction of cumulative dose of steroids and then an improvement of bone loss in the post-transplant period was expected. In a previous cross-sectional study performed in 24 patients during the early phase after kidney transplantation (Tx) we found a mild to moderate bone mineral density (BMD) loss that was not associated to steroid treatment and seemed to be related to the preexisting condition of secondary hyperparathyroidism . Then, in order to better evaluate the behaviour of bone mineralization after Tx, we studied the BMD 6 and 18 months after surgery in a selected group of patients who underwent their first kidney Tx. We studied 13 patients (12 males, 1 females), aged 39.7 ± 7.3 years, with duration of dialysis treatment of 50.1 ± 40.0 months, a good renal function recovery (mean serum creatinine 1.33 ± 0.2 mg/dl), treated with the conventional steroid and immunosuppressive therapy. We evaluated plasma levels of calcium, phosphorus, total alkaline phosphatase activity (ALP), serum intact parathyroid hormone (PTH), using standard techniques both 6 and 18 months after Tx. BMD was evaluated by DEXA (dual energy x-ray absorptiometry; Hologic QDR 1000) at lumbar spine (L1-L4) and proximal femur (neck), and osteosonography (DBM Sonic BP) at the phalanges of non dominant hand, measuring amplitude-dependent speed of sound (Ad-SoS). 6 months after Tx both clinical and biochemical parameters showed almost normal values and did not change throughout the study (PTH 102±60 pg/ml, phosphorus 2.81±.0.74 mg/dl, ALP 226.3±119.1 U/L, Calcium 10.1±0.58 mg/dl). 18 months after Tx lumbar spine BMD averaged values significantly lower as compared to control (6 months) both when evaluated as g/cm² (0.87± 0.11 vs 0.91± 0.13, p=0.01) and as Z-score (-1.87± 0.97 vs -1.47± 1.17, p=0.01). Femoral neck BMD averaged lower values as compared to control (6 months) both when evaluated as g/cm² (0.72± 0.18 vs 0.76± 0.18, p=0.07) and as Z-score (-1.60± 1.15 vs -1.23± 1.51, p=0.09) despite the differences were not statistically significant. Notwithstanding this, according to WHO criteria, all the patients showed a worsening in BMD at this site when evaluated as T-score. Furthermore 18 months after Tx the phalanges BMD averaged values significantly lower as compared to control both when evaluated as Ad-SoS (2031± 55 m/s vs 2059± 72, p<0.05) and as Z-score (-1.08± 0.73 vs -0.70± 0.93, p<0.05). Multivariate analysis were performed at each skeleton site using ΔBMD as dipendent variable and BMI, age, corticosteroid cumulative dose, Δcorticosteroid cumulative dose, ΔPTH and cyclosporine A cumulative dose as covariates. Our data show that bone mass loss is still an important and worsening complication at least in the first two years after kidney Tx. Moreover, despite the significant cumulative dose reduction, steroid treatment seems to be the most relevant factor in inducing BMD loss in these patients. Keywords: transplant: complications; bone diseases; cyclosporine; steroids

KIDNEY TRANSPLANTATION AND BONE MASS: A CONTROLLED STUDY SIX AND EIGHTEEN MONTHS AFTER SURGERY / Balletta, MARIO MARIA; Esposito, Pasquale; Luigi, Marzano; Ragosta, Annalisa; Minale, Bruno; Carrano, Rosa; Russo, Domenico; Puente, Antonio Del; Carpinelli, Assunta; Padula, Stefania; Federico, Stefano. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2003). (Intervento presentato al convegno World Congress of Nephrology tenutosi a Berlin nel 8-12 june 2003).

KIDNEY TRANSPLANTATION AND BONE MASS: A CONTROLLED STUDY SIX AND EIGHTEEN MONTHS AFTER SURGERY

BALLETTA, MARIO MARIA;RUSSO, DOMENICO;FEDERICO, STEFANO
2003

Abstract

The introduction of cyclosporine has allowed a reduction of cumulative dose of steroids and then an improvement of bone loss in the post-transplant period was expected. In a previous cross-sectional study performed in 24 patients during the early phase after kidney transplantation (Tx) we found a mild to moderate bone mineral density (BMD) loss that was not associated to steroid treatment and seemed to be related to the preexisting condition of secondary hyperparathyroidism . Then, in order to better evaluate the behaviour of bone mineralization after Tx, we studied the BMD 6 and 18 months after surgery in a selected group of patients who underwent their first kidney Tx. We studied 13 patients (12 males, 1 females), aged 39.7 ± 7.3 years, with duration of dialysis treatment of 50.1 ± 40.0 months, a good renal function recovery (mean serum creatinine 1.33 ± 0.2 mg/dl), treated with the conventional steroid and immunosuppressive therapy. We evaluated plasma levels of calcium, phosphorus, total alkaline phosphatase activity (ALP), serum intact parathyroid hormone (PTH), using standard techniques both 6 and 18 months after Tx. BMD was evaluated by DEXA (dual energy x-ray absorptiometry; Hologic QDR 1000) at lumbar spine (L1-L4) and proximal femur (neck), and osteosonography (DBM Sonic BP) at the phalanges of non dominant hand, measuring amplitude-dependent speed of sound (Ad-SoS). 6 months after Tx both clinical and biochemical parameters showed almost normal values and did not change throughout the study (PTH 102±60 pg/ml, phosphorus 2.81±.0.74 mg/dl, ALP 226.3±119.1 U/L, Calcium 10.1±0.58 mg/dl). 18 months after Tx lumbar spine BMD averaged values significantly lower as compared to control (6 months) both when evaluated as g/cm² (0.87± 0.11 vs 0.91± 0.13, p=0.01) and as Z-score (-1.87± 0.97 vs -1.47± 1.17, p=0.01). Femoral neck BMD averaged lower values as compared to control (6 months) both when evaluated as g/cm² (0.72± 0.18 vs 0.76± 0.18, p=0.07) and as Z-score (-1.60± 1.15 vs -1.23± 1.51, p=0.09) despite the differences were not statistically significant. Notwithstanding this, according to WHO criteria, all the patients showed a worsening in BMD at this site when evaluated as T-score. Furthermore 18 months after Tx the phalanges BMD averaged values significantly lower as compared to control both when evaluated as Ad-SoS (2031± 55 m/s vs 2059± 72, p<0.05) and as Z-score (-1.08± 0.73 vs -0.70± 0.93, p<0.05). Multivariate analysis were performed at each skeleton site using ΔBMD as dipendent variable and BMI, age, corticosteroid cumulative dose, Δcorticosteroid cumulative dose, ΔPTH and cyclosporine A cumulative dose as covariates. Our data show that bone mass loss is still an important and worsening complication at least in the first two years after kidney Tx. Moreover, despite the significant cumulative dose reduction, steroid treatment seems to be the most relevant factor in inducing BMD loss in these patients. Keywords: transplant: complications; bone diseases; cyclosporine; steroids
2003
KIDNEY TRANSPLANTATION AND BONE MASS: A CONTROLLED STUDY SIX AND EIGHTEEN MONTHS AFTER SURGERY / Balletta, MARIO MARIA; Esposito, Pasquale; Luigi, Marzano; Ragosta, Annalisa; Minale, Bruno; Carrano, Rosa; Russo, Domenico; Puente, Antonio Del; Carpinelli, Assunta; Padula, Stefania; Federico, Stefano. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - (2003). (Intervento presentato al convegno World Congress of Nephrology tenutosi a Berlin nel 8-12 june 2003).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/682589
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