Avascular osteonecrosis (AVN) is the most disabling bone complication after kidney transplantation (KT). Its incidence decreased from 15% to 4% after the introduction of cyclosporine and the consequent decrease in glucocorticoid dose. Recent data about incidence and risk factors are lacking.

We performed an ambispective study in 807 patients who underwent KT between January 2004 and June 2014. Median follow-up after KT was 64 months. Symptomatic AVN were diagnosed by magnetic resonance imaging or computerized tomography. AVN was diagnosed in 32 patients (24 men and 8 women, incidence of 3.97%). AVN occurred before KT in 15 patients (1.86%) or/and after KT in 18 patients (2.23%). In the post-transplantation AVN group (PTAVN), mean age at diagnosis was 53 +/- 13 years. The median time from KT to first symptom of AVN was 12 months (range 1-99). The AVN sites included the femoral head (15 patients), the femoral condyle (2 patients) and the ankle (1 patient). At diagnosis, 10 patients (56%) had several localizations of AVN. The oral corticosteroid dose was higher in the PTAVN group compared to the non-AVN group (NAVN) (mean daily dose during the first post-transplant year of 11.2 mg/day versus 7.7 mg/d, p<0.01). Each dose increase of 10 mg/day increased by 3.9 fold the risk of AVN. The acute rejection rate was higher among the PTAVN group than the NAVN group (50 vs 23.5%, p<0.01). The BMI was also higher in the PTAVN group (p<0.01). There were no differences concerning the other potential risk factors.

In conclusion, the current cumulative incidence of AVN in KT recipients remains significant about 4%. This study shows clearly that the corticosteroid dose notably used in case of acute rejection and that overweight are the main current risk factors in this population.

CITATION INFORMATION: Perrin P, Felten R, Caillard S, Schaeffer M, Moulin B, Javier R.-M. Avascular Necrosis in Kidney Transplant Recipients: Recent Data from a Cohort Study. Am J Transplant. 2017;17 (suppl 3).

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