*Purpose: Avascular necrosis (AVN) is one of the most common bone complications after kidney transplantation. In recent years, it has become an important morbidity with the increase in the number of patients with successful renal transplantation and the prolongation of follow-up periods following transplantation. The incidence of AVN was 20% before 2000 but decreased to 4-11% in recent studies with the use of calcineurin inhibitors. Although corticosteroids play an important role in the etiopathogenesis, no clear consensus has been reached for other risk factors. The aim of our study was to determine the frequency of AVN in our patients and to identify risk factors that may be associated with AVN development

*Methods: A total of 421 patients who were followed-up at Renal Transplantation Unit between 1985 and 2019 were included in the study. The demographic and clinical data of the patients were obtained retrospectively from the patient files. The AVN arm of the study consisted of radiologically diagnosed patients. Risk factors were analyzed by comparing clinical and demographic characteristics of patients with and without AVN

*Results: The incidence of AVN in our kidney transplantation population was found to be 8.2% (n=35). The median period for the development of symptomatic AVN was 15 (2-94) months. The prevelance of AVN was found to be significantly higher in the years before 2000 and then years after, 20,2 % and 7,2%respectively (p=0.0005). BMI and cyclosporine use were not found to be risk factors for AVN development (p=0.283, p=0.164). Although cumulative steroid doses in the first 12 months period were higher in the AVN group, it was not found to be an independent risk factor for AVN development. Azathioprine use (p=0.022), in the posttransplant first year, presence of hyperparathyroidism (p=0.009), glomerulonephritis as the primary disease (p=0.003) and pulse steroid use (p=0.009) were found as independent risk factors for development of AVN. While 34.3% of the patients who developed AVN required surgical intervention, 54.3% were treated conservatively.

*Conclusions: In our study, although the cumulative steroid use of steroids was not directly associated with AVN development, pulse steroid use was. The majör other associations were with presence of hyperparathyroidism, glomerulonephritis as primary disease and use of azathioprin. These associations need to be further investigated in larger patient populations.

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