scholarly journals Follow-Up of Bone Mineral Density Changes in de novo Kidney Transplant Recipients Treated with Two Doses of the Receptor Activator of Nuclear Factor κB Ligand Inhibitor Denosumab

2019 ◽  
Vol 44 (5) ◽  
pp. 1285-1293 ◽  
Author(s):  
Claudia Kobel ◽  
Diana Frey ◽  
Nicole Graf ◽  
Rudolf P. Wüthrich ◽  
Marco Bonani
Keyword(s):  
Lumbar Spine ◽  
Standard Treatment ◽  
De Novo ◽  
Control Group ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Discontinuation Of Treatment ◽  
Monthly Change

Background: Studies in women with post-menopausal osteoporosis have shown that discontinuation of treatment with denosumab leads to an increased risk of vertebral fractures because of rebound bone turnover and rapid loss of bone mineral density (BMD). Methods: In a post hoc analysis of the Prolia for Osteoporosis of Transplant Operated Patient study, we analyzed the effect of denosumab withdrawal on BMD changes. Twenty-five de novo kidney transplant recipients (KTR) who were treated for 1 year with 2 six-monthly doses of denosumab on top of standard treatment (daily calcium and vitamin D) were compared to a control group of 29 KTR who received standard treatment alone. BMD changes were analyzed by repeated dual-energy X-ray absorptiometry shortly after transplantation (baseline), after 6 and 12 months (active treatment phase) and after 2–6.5 years (follow-up phase). Results: The average BMD at the lumbar spine declined markedly after discontinuation of treatment with denosumab but increased again thereafter. Thus, the average monthly change in lumbar spine BMD from month 12 onward was only 0.1 ± 2.8‰ in the denosumab group but 1.5 ± 1.9‰ in the control group (p = 0.021). The average monthly change in lumbar spine BMD from baseline to follow-up was similar in the control and denosumab group (1.1 ± 1.2‰ vs. 1.5 ± 2.4‰, p = 0.788). Similar results were seen at the total hip. Conclusions: In de novo KTR treated with 2 doses of denosumab, we detect a marked decrease in lumbar spine and hip BMD when denosumab is discontinued. Denosumab treatment should therefore not be discontinued without considering an alternative antiresorptive treatment.

scholarly journals Effect of denosumab on trabecular bone score in de novo kidney transplant recipients

2019 ◽  
Vol 34 (10) ◽  
pp. 1773-1780 ◽  
Author(s):  
Marco Bonani ◽  
Diana Frey ◽  
Nicole Graf ◽  
Rudolf P Wüthrich
Keyword(s):  
Lumbar Spine ◽  
Trabecular Bone ◽  
Kidney Transplant ◽  
De Novo ◽  
Trabecular Bone Score ◽  
Distal Tibia ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Total Hip

Abstract Background Kidney transplant recipients (KTR) are at risk to lose bone mass. The trabecular bone score (TBS) represents a recently developed parameter of lumbar spine trabecular bone texture that correlates with the occurrence of fractures. Methods We analysed the 1-year changes in TBS in 44 de novo KTR that were randomized 1:1 to denosumab or no treatment. TBS was derived from dual energy X-ray absorptiometry and was correlated with 1-year areal bone mineral density (aBMD) changes at the lumbar spine and total hip. Correlations were also performed with parameters of peripheral bone microarchitecture and bone strength at the distal tibia and distal radius, as assessed by high-resolution peripheral quantitative computed tomography (HRpQCT) and micro-finite element analysis. Results The baseline TBS in KTR amounted to 1.312 ± 0.101, which is lower than the TBS of an age-matched normal control population (range 1.364–1.471). The TBS correlated positively with aBMD at the lumbar spine (Spearman’s ρ = 0.56; P < 0.001) and total hip (ρ = 0.33; P < 0.05). The baseline TBS also correlated with HRpQCT-derived total (ρ = 0.49; P < 0.05) and trabecular volumetric BMD (ρ = 0.57; P < 0.01) and trabecular separation (ρ = −0.46; P < 0.05) at the tibia. Denosumab treatment led to an increase in TBS, paralleling the BMD changes at the lumbar spine. Conclusions The TBS is a useful additional score of bone health, which may help to better define fracture risk. Treatment with denosumab led to improved trabecular bone texture in de novo KTR in addition to its beneficial effect on BMD.

Denosumab-Induced Hypocalcemia and Hyperparathyroidism in de novo Kidney Transplant Recipients

2021 ◽  
pp. 1-9
Author(s):  
Giuseppe Cianciolo ◽  
Francesco Tondolo ◽  
Simona Barbuto ◽  
Francesca Iacovella ◽  
Guido Zavatta ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Bone Disease ◽  
De Novo ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density

<b><i>Introduction:</i></b> Denosumab represents a realistic treatment option to increase bone mineral density in kidney transplant recipients (KTRs). It is still unknown how and at what extent posttransplantation bone disease and graft function influence the effects of denosumab on mineral metabolism indexes. In this study, we analyze risk factors of hypocalcemia and parathyroid hormone (PTH) increase after denosumab administration in eighteen de novo KTRs and its management before and after this treatment. <b><i>Methods:</i></b> We conducted a monocentric, observational, prospective study on de novo KTRs. All KTRs enrolled received a single 60 mg subcutaneous dose of denosumab every 6 months. Before kidney transplantation, no patients were treated with calcio-mimetic. After kidney transplantation and before antiresorptive therapy, no patients were treated with calcio-mimetic drugs and/or vitamin D receptor agonists, while all patients received nutritional vitamin D supplementation (from 1,000 IU to 1,500 IU daily). <b><i>Results:</i></b> Hypocalcemia was related to the degree of lumbar osteoporosis (<i>p</i> = 0.047); the increase in the PTH level was correlated to baseline bone turnover markers (bone alkaline phosphatase, serum osteocalcin, and β-C-terminal telopeptide), the 25 OH status, and eGFR. The introduction of calcitriol, after the PTH increase, in addition to cholecalciferol was necessary to ensure an adequate control of serum calcium and PTH during a follow-up of 15 months. Following the treatment with denosumab, it was observed an improvement of areal bone mineral density both at lumbar and femoral sites with a mean percentual increase of 1.74% and 0.25%, respectively. <b><i>Conclusions:</i></b> Denosumab is an effective treatment for bone disease in KTRs. In our study, the increase in PTH is not a transient event but prolonged throughout the follow-up period and requires continuous supplementation therapy with calcitriol.

scholarly journals Alendronate as an Effective Treatment for Bone Loss and Vascular Calcification in Kidney Transplant Recipients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Masanori Okamoto ◽  
Shintaro Yamanaka ◽  
Wataru Yoshimoto ◽  
Takashi Shigematsu
Keyword(s):  
Bone Loss ◽  
Effective Treatment ◽  
Kidney Transplant ◽  
Vascular Calcification ◽  
Secondary Osteoporosis ◽  
Control Group ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Group A

Kidney transplant recipients develop secondary osteoporosis induced by immunosuppressive medication, with a high risk of fracture, and abdominal aortic calcification (AC) is a known predictor of cardiovascular mortality. In this study of 12 stable kidney recipients, we estimated the preventive effect of bisphosphonate treatment on bone loss and progression of AC. We randomly divided the subjects into a treatment group with alendronate (group A: 5 subjects) and a control group (group C: 7 subjects). Group A patients received 35 mg/week of alendronate over 24 months, while group C patients were not administered with any bisphosphonates. Two major endpoints were established: (1) the time-dependent change in bone mineral density (BMD) estimated with DEXA and (2) progression of abdominal AC, calculated twice as an index (ACI) using computed tomography data. Over the 2-year study period, group A patients showed significantly increased BMD of 1.86 ± 0.85% (P=0.015versus baseline), and almost complete inhibition of ACI progression (38.2 ± 24.2% to 39.6 ± 24.3%), but group C patients showed a decrease in BMD decline with bone loss and progression of ACI (32.8 ± 25.0% to 37.8 ± 29.2%,P=0.061). In conclusion, alendronate therapy was an effective treatment in kidney transplant recipients for secondary osteoporosis and vascular calcification as ectopic calcification. This clinical trial is registered with number JMA-IIA00155 of JMACCT CTR.

scholarly journals Long‐term, prolonged‐release tacrolimus‐based immunosuppression in de novo kidney transplant recipients: 5‐year prospective follow‐up of the ADHERE study patients

2019 ◽  
Vol 33 (2) ◽  
pp. 161-173
Author(s):  
Oleg Rummo ◽  
Mario Carmellini ◽  
Nassim Kamar ◽  
Antoine Durrbach ◽  
Christiane Mousson ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Prolonged Release ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients

scholarly journals Incidence and Impacts of Inflammatory Bowel Diseases among Kidney Transplant Recipients: A Meta-Analysis

2020 ◽  
Vol 8 (3) ◽  
pp. 39
Author(s):  
Panupong Hansrivijit ◽  
Max M. Puthenpura ◽  
Charat Thongprayoon ◽  
Himmat S. Brar ◽  
Tarun Bathini ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Meta Analysis ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplant ◽  
Adult Kidney ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Background: The incidence of inflammatory bowel diseases (IBD) and its significance in kidney transplant recipients is not well established. We conducted this systematic review and meta-analysis to assess the incidence of and complications from IBD in adult kidney transplant recipients. Methods: Eligible articles were searched through Ovid MEDLINE, EMBASE, and the Cochrane Library from inception through April 2020. The inclusion criteria were adult kidney transplant patients with reported IBD. Effect estimates from the individual studies were extracted and combined using the fixed-effects model when I2 ≤ 50% and random-effects model when I2 > 50%. Results: of 641 citations, a total of seven studies (n = 212) were included in the systematic review. The mean age was 46.2 +/− 6.9 years and up to 51.1% were male. The mean duration of follow-up was 57.8 +/− 16.8 months. The pooled incidence of recurrent IBD was 27.6% (95% CI, 17.7–40.5%; I2 0%) while the pooled incidence of de novo IBD was 18.8% (95% CI, 10.7–31.0%; I2 61.3%). The pooled incidence of post-transplant IBD was similar across subgroup analyses. Meta-regression analyses showed no association between the incidence of IBD and age, male sex, and follow-up duration. For post-transplant complications, the pooled incidence of post-transplant infection was 4.7% (95% CI, 0.5–33.3%; I2 73.7%). The pooled incidence of graft rejection and re-transplantation in IBD patients was 31.4% (95% CI, 14.1–56.1%; I2 76.9%) and 30.4% (95% CI, 22.6–39.5%; I2 0%). Conclusion: Recurrent and de novo IBD is common among kidney transplant recipients and may result in adverse outcomes.

scholarly journals Bone mineral density, bone turnover markers, and incident fractures in de novo kidney transplant recipients

2019 ◽  
Vol 95 (6) ◽  
pp. 1461-1470 ◽  
Author(s):  
Pieter Evenepoel ◽  
Kathleen Claes ◽  
Bjorn Meijers ◽  
Michaël R. Laurent ◽  
Bert Bammens ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Turnover ◽  
Kidney Transplant ◽  
Bone Mineral ◽  
Bone Turnover Markers ◽  
De Novo ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Mineral Density ◽  
Turnover Markers

scholarly journals Immunosuppression minimization in kidney transplant recipients hospitalized for COVID-19

2021 ◽  
Author(s):  
Paula Anton Pampols ◽  
Hernando Trujillo ◽  
Edoardo Melilli ◽  
Blanca Urban ◽  
Justo Sandino ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
De Novo ◽  
Graft Function ◽  
Immunosuppressive Agent ◽  
Immunosuppressive Drugs ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Immunosuppressed Patients ◽  
The Impact

Abstract Background Immunosuppressed patients such as kidney transplant recipients (KTs) have increased mortality risk in the setting of coronavirus disease 2019 (COVID-19). The role and management of chronic immunosuppressive therapies during COVID-19 must be characterized. Methods Herein, we report the follow-up of a cohort of 47 KTs admitted at two Spanish Kidney Transplant Units, who survived COVID-19. The impact of the management of immunosuppression during COVID-19 on graft function and immunologic events was evaluated. Results At least one immunosuppressive agent was withdrawn in 83% of patients, with antimetabolites being the most frequent. Steroids were generally not stopped and the dose was even increased in 15% of patients as part of the treatment of COVID-19. Although immunosuppressive drugs were suspended during a median time of 17 days, no rejection episodes or de novo donor-specific antibodies were observed up to 3 months after discharge, and no significant changes occurred in calculated panel reactive antibodies. Acute graft dysfunction was common (55%) and the severity was related to tacrolimus trough levels, which were higher in patients receiving antivirals. At the end of follow-up, all patients recovered baseline kidney function. Conclusions Our observational study suggests that immunosuppression in KTs hospitalized due to COVID-19 could be safely minimized.

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