scholarly journals Bone disease after transplantation: osteoporosis and fractures risk

2014 ◽  
Vol 58 (5) ◽  
pp. 484-492 ◽  
Author(s):  
Carolina A. M. Kulak ◽  
Victoria Z. C. Borba ◽  
Jaime Kulak Júnior ◽  
Melani Ribeiro Custódio
Keyword(s):  
Bone Loss ◽  
Organ Transplantation ◽  
Bone Disease ◽  
Immunosuppressive Agents ◽  
Fragility Fractures ◽  
First Year ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
End Stage

Organ transplantation is the gold standard therapy for several end-stage diseases. Bone loss is a common complication that occurs in transplant recipients. Osteoporosis and fragility fractures are serious complication, mainly in the first year post transplantation. Many factors contribute to the pathogenesis of bone disease following organ transplantation. This review address the mechanisms of bone loss including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and management of bone loss in the transplant recipient should be included in their post transplant follow-up in order to prevent fractures.

scholarly journals Post-transplantation osteoporosis

2010 ◽  
Vol 54 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Carolina A. Moreira Kulak ◽  
Victória Z. Cochenski Borba ◽  
Jaime Kulak Júnior ◽  
Denise Jonhsson Campos ◽  
Elizabeth Shane
Keyword(s):  
Bone Marrow ◽  
Bone Loss ◽  
Organ Transplantation ◽  
Immunosuppressive Agents ◽  
Fragility Fractures ◽  
Post Transplantation ◽  
Hematologic Disorders ◽  
High Incidence ◽  
Prevention And Treatment ◽  
End Stage

Transplantation is an established therapy for many hematologic disorders as well as for end-stage diseases of the kidney, lung, liver, heart among others. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods including the contribution of immunosuppressive agents as well as the specific features of bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis in the transplant recipient will also be addressed.

scholarly journals Transplantation osteoporosis

2006 ◽  
Vol 50 (4) ◽  
pp. 783-792 ◽  
Author(s):  
Carolina A.M. Kulak ◽  
Victoria Z.C. Borba ◽  
Jaime Kulak Júnior ◽  
Elizabeth Shane
Keyword(s):  
Bone Loss ◽  
Organ Transplantation ◽  
Late Phase ◽  
Fragility Fractures ◽  
Transplant Recipients ◽  
The Past ◽  
High Incidence ◽  
End Stage ◽  
Improvement In Survival

In the past two decades, there has been a rapid increase in the number of organ transplanted worldwide, including Brazil, along with an improvement in survival and quality of life of the transplant recipients. Osteoporosis and a high incidence of fragility fractures have emerged as a complication of organ transplantation. Many factors contribute to the pathogenesis of osteoporosis following organ transplantation. In addition, most patients have some form of bone disease prior to transplantation, which is usually related to adverse effects of end-stage organ failure on the skeleton. This chapter reviews the mechanisms of bone loss that occur both in the early and late post-transplant periods, as well as the features specific to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and treatment for osteoporosis should be instituted prior and in the early and late phase after transplantation, and will also be addressed in this article.

Adapted Management of EBV Reactivation After Solid Organ Transplantation: An Effective Prevention of Post Transplantation Lymphoproliferative Disorders (PTLD). Results of the Largest Prospective Study on 251 Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 592-592
Author(s):  
Sylvain Choquet ◽  
Shaida Varnous ◽  
Claire Deback ◽  
Alain Pavie ◽  
Véronique Leblond
Keyword(s):  
Viral Load ◽  
Board Of Directors ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
First Year ◽  
Solid Organ ◽  
Post Transplantation ◽  
Advisory Committees ◽  
Ebv Reactivation

Abstract Abstract 592 Background: PTLD represent a rare but aggressive graft complication. Patients who have received a solid organ transplantation have a 20 to 120 fold higher incidence of non-Hodgkin's lymphoma. EBV reactivation represents a major predictive factor for PTLD, especially during the first year after transplantation, but there is no consensual attitude in this situation Aim: We conducted a monocentric prospective study in the Hospital of Pitie Salpêtriere, Paris, France, on all new heart transplanted patients. EBV viral load (EVL) on whole blood samples was systematically followed and confirmed reactivations were treated depending on viral load. Methods: All heart transplanted patients who had at least one EVL between January 2004 and December 2008 were included. Immunosuppression consisted on anti-lymphocyte sera, ciclosporin, mycophenolate-mofetyl (MM) and prednisone. Twelve to 15 blood samples per year were analysed. If the EVL was more than 105 copies/ml, a CT scan or a PET-san was performed in order to detect any PTLD and patients were treated by diminution of the immunosupression (DIS), mainly by MM arrest. One injection of Rituximab (R) (375 mg/m2) was used in case of failure and/or if EVL was over 106 copies/ml. Results: A total of 251 patients were included, 59 femals/192 men, of a median age of 50 years [16-72]. All but 6 were EBV positive before the graft. Reactivations were detected in 29 cases (11,55%) and treated by DIS only in 20 cases, DIS followed by R in 5 and directly by DIS and R in 4. All EBV negative patients developed a primoinfection in the first year, 2 with an EVL over 105, one presented non documented hepatic lesions which disappeared after DIS. All EBV reactivations were controlled, with a relapse in only one case (reactivations treated the first time by DIS, 10 months later by DIS and R and 6 months later by DIS). With a median follow-up of 1118 days [53-2100] only one PTLD has been diagnosed (in a patient lost to follow up and taken in charge in an other unit) and 24 patients died (9,5%). Analyse of DIS +/− R on graft rejection and potential link between CMV reactivation and EBV reactivation will be presented at the ASH. From 1987 to December 2003, 24 (1,8/year) PTLD have been treated in the same unit (18 EBV positive, 5 negative, 1 unknown), of which 13 were early PTLD (all EBV positive) diagnosed within one year post transplantation. Conclusions: EBV reactivation after organ transplantation can be managed by diminution of immunosupression and/or rituximab, depending on viral load, without serious complication. This adapted management seems to decrease dramatically the incidence of EBV positive PTLD. Disclosures: Choquet: ROCHE: Consultancy. Leblond:ROCHE: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; MUNDIPHARMA: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CELGENE: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees.

scholarly journals Prevention of Fractures after Solid Organ Transplantation: A Meta-Analysis

2011 ◽  
Vol 96 (11) ◽  
pp. 3457-3465 ◽  
Author(s):  
Emily M. Stein ◽  
Dionisio Ortiz ◽  
Zhezhen Jin ◽  
Donald J. McMahon ◽  
Elizabeth Shane
Keyword(s):  
Bone Loss ◽  
Organ Transplantation ◽  
Vertebral Fractures ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Cochrane Library ◽  
First Year ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Mineral Density

Abstract Context: Bone loss and fracture are serious sequelae of organ transplantation, particularly in the first posttransplant year. Most interventional studies have been inadequately powered to detect effects on fracture. Objective: The objective of the study was to determine whether treatment with bisphosphonates (BP) or active vitamin D analogs (vitD) during the first year after transplantation reduces fracture risk and estimate the effect of these interventions on bone loss. Data Sources: Sources included PUBMED, MEDLINE, Cochrane Library, and abstracts from scientific meetings (presented 2003–2010). Study Selection: Randomized controlled clinical trials of BP or vitD in solid organ transplant recipients were included if treatment was initiated at the time of transplantation and fracture data were collected. Data Extraction: Two investigators independently extracted data and rated study quality. Fixed effect and random-effects models were used to obtain pooled estimates. Data Synthesis: Eleven studies of 780 transplant recipients (134 fractures) were included. Treatment with BP or vitD reduced the number of subjects with fracture [odds ratio (OR) 0.50 (0.29, 0.83)] and number of vertebral fractures, [OR 0.24 (0.07, 0.78)]. An increase in bone mineral density at the lumbar spine [2.98% (1.31, 4.64)] and femoral neck [3.05% (2.16, 3.93)] was found with treatment. When BP trials (nine studies, 625 subjects) were examined separately, there was a reduction in number of subjects with fractures [OR 0.53 (0.30, 0.91)] but no significant reduction in vertebral fractures [OR 0.34 (0.09, 1.24)]. Conclusions: Treatment with BP or vitD during the first year after solid organ transplant was associated with a reduction in the number of subjects with fractures and fewer vertebral fractures.

scholarly journals BK Polyomavirus Micro-RNAs: Time Course and Clinical Relevance in Kidney Transplant Recipients

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 351
Author(s):  
Baptiste Demey ◽  
Véronique Descamps ◽  
Claire Presne ◽  
Francois Helle ◽  
Catherine Francois ◽  
...  
Keyword(s):  
Viral Replication ◽  
Kidney Transplant ◽  
Clinical Relevance ◽  
Graft Loss ◽  
First Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Post Transplantation ◽  
Bk Polyomavirus ◽  
Micro Rnas

Background: Kidney transplant recipients (KTRs) are exposed to a high risk of BK polyomavirus (BKPyV) replication, which in turn may lead to graft loss. Although the microRNAs (miRNAs) bkv-miR-B1-3p and bkv-miR-B1-5p are produced during the viral cycle, their putative value as markers of viral replication has yet to be established. In KTRs, the clinical relevance of the changes over time in BKPyV miRNA levels has not been determined. Methods: In a retrospective study, we analyzed 186 urine samples and 120 plasma samples collected from 67 KTRs during the first year post-transplantation. Using a reproducible, standardized, quantitative RT-PCR assay, we measured the levels of bkv-miR-B1-3p and bkv-miR-B1-5p (relative to the BKPyV DNA load). Results: Detection of the two miRNAs had low diagnostic value for identifying patients with DNAemia or for predicting DNAuria during follow-up. Seven of the 14 KTRs with a sustained BKPyV infection within the first year post-transplantation showed a progressive reduction in the DNA load and then a rapid disappearance of the miRNAs. DNA and miRNA loads were stable in the other seven KTRs. Conclusions: After the DNA-based diagnosis of BKPyV infection in KTRs, bkv-miR-B1-3p and bkv-miR-B1-5p levels in the urine might be valuable markers for viral replication monitoring and thus might help physicians to avoid an excessive reduction in the immunosuppressive regimen.

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

scholarly journals Acceptance and Use of Mobile Technology for Health Self-Monitoring in Lung Transplant Recipients during the First Year Post-Transplantation

2016 ◽  
Vol 07 (02) ◽  
pp. 430-445 ◽  
Author(s):  
Susan Sereika ◽  
Annette DeVito Dabbs ◽  
Steven Handler ◽  
Elizabeth Schlenk ◽  
Yun Jiang
Keyword(s):  
Mobile Technology ◽  
Physical Functioning ◽  
Lung Transplant ◽  
Technology Training ◽  
First Year ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Self Monitoring ◽  
Use Of Technology ◽  
Lung Transplant Recipients

SummaryTo describe lung transplant recipients (LTRs’) acceptance and use of mobile technology for health self-monitoring during the first year post-transplantation, and explore correlates of the use of technology in the 0 to 2, >2 to ≤6, >6 to ≤12, and 0 to 12 months.Secondary analysis of data from 96 LTR assigned to use Pocket PATH®, a smartphone application, for daily health self-monitoring in a randomized controlled trial. Use of Pocket PATH was categorized as low, moderate, and high use. Proportional odds models for ordinal logistic regression were employed to explore correlates of use of technology.LTR reported high acceptance of Pocket PATH at baseline. However, acceptance was not associated with actual use over the 12 months (p=0.45∼0.96). Actual use decreased across time intervals (p<0.001). Increased self-care agency was associated with the increased odds of higher use in women (p=0.03) and those less satisfied with technology training (p=0.02) in the first 2 months. Higher use from >2 to ≤6 months was associated with greater satisfaction with technology training (OR=3.37, p=0.01) and shorter length of hospital stay (OR=0.98, p=0.02). Higher use from >6 to ≤12 months was associated with older age (OR=1.05, p=0.02), lower psychological distress (OR=0.43, p=0.02), and better physical functioning (OR=1.09, p=0.01). Higher use over 12 months was also associated with older age (OR=1.05, p=0.007), better physical functioning (OR=1.13, p=0.001), and greater satisfaction with technology training (OR=3.05, p=0.02).Correlates were different for short- and long-term use of mobile technology for health self-monitoring in the first year post-transplantation. It is important to follow up with LTR with longer hospital stay, poor physical functioning, and psychological distress, providing ongoing education to improve their long-term use of technology for health self-monitoring.Citation: Jiang Y, Sereika SM, DeVito Dabbs A, Handler SM, Schlenk EA. Acceptance and use of mobile technology for health self-monitoring in lung transplant recipients during the first year post-transplantation.

First-year estimated glomerular filtration rate variability after pre-end-stage renal disease program enrollment and adverse outcomes of chronic kidney disease

2018 ◽  
Vol 34 (12) ◽  
pp. 2066-2078 ◽  
Author(s):  
Ching-Wei Tsai ◽  
Han-Chun Huang ◽  
Hsiu-Yin Chiang ◽  
Chih-Wei Chung ◽  
Hsien-Tsai Chiu ◽  
...  
Keyword(s):  
End Stage Renal Disease ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Longitudinal Change ◽  
First Year ◽  
Program Enrollment ◽  
Stage Renal Disease ◽  
End Stage ◽  
Egfr Slope

Abstract Background Scarce evidence associates the first-year estimated glomerular filtration rate (eGFR) variability and longitudinal change scales concomitantly to the risk of developing end-stage renal disease (ESRD), acute coronary syndrome (ACS) and death following pre-ESRD program enrollment in chronic kidney disease (CKD). Methods We conducted a prospective cohort study of 5092 CKD patients receiving multidisciplinary care between 2003 and 2015 with careful ascertainment of ESRD, ACS and death during the follow-up. First-year eGFR variability and longitudinal change scales that were based on all first-year eGFR measurements included coefficient of variation of eGFR (eGFR-CV), percent change (eGFR-PC), absolute difference (eGFR-AD), slope (eGFR-slope) and area under the curve (AUC). Results A total of 786 incident ESRD, 292 ACS and 410 death events occurred during the follow-up. In the multiple Cox regression, the fully adjusted hazard ratios (HRs) of progression to ESRD for each unit change in eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope, eGFR-AUC were 1.03 [95% confidence interval (CI) 1.02–1.04], 1.04 (1.03–1.04), 1.16 (1.14–1.18), 1.16 (1.14–1.17) and 1.04 (1.03–1.04), respectively. The adjusted HRs for incident ESRD comparing the extreme with the reference quartiles of eGFR-CV, eGFR-PC, eGFR-AD, eGFR-slope and eGFR-AUC were 2.67 (95% CI 2.11–3.38), 8.34 (6.33–10.98), 19.08 (11.89–30.62), 13.08 (8.32–20.55) and 6.35 (4.96–8.13), respectively. Similar direction of the effects on the risk of developing ACS and mortality was observed. In the 2 × 2 risk matrices, patients with the highest quartile of eGFR-CV and concomitantly with the most severely declining quartiles of any other longitudinal eGFR change scale had the highest risk of all outcomes. Conclusions The dynamics of eGFR changes, both overall variability and longitudinal changes, over the first year following pre-ESRD program enrollment are crucial prognostic factors for the risk of progression to ESRD, ACS and deaths among patients with CKD. A risk matrix combining the first-year eGFR variability and longitudinal change scales following pre-ESRD enrollment is a novel approach for risk characterization in CKD care. Randomized trials in CKD may be required to ascertain comparable baseline eGFR dynamics.

scholarly journals AI-related BMD variation in actual practice conditions: A prospective cohort study

2016 ◽  
Vol 23 (4) ◽  
pp. 303-312 ◽  
Author(s):  
María Rodríguez-Sanz ◽  
Daniel Prieto-Alhambra ◽  
Sonia Servitja ◽  
Natalia Garcia-Giralt ◽  
Laia Garrigos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Bone Loss ◽  
Fragility Fractures ◽  
Vitamin D Supplementation ◽  
Actual Practice ◽  
First Year ◽  
Breast Cancer Patients ◽  
Mineral Density ◽  
25 Hydroxy Vitamin D

Abstract The aim of the study was to evaluate the progression of bone mineral density (BMD) during 3 years of aromatase inhibitors (AI) therapy in actual practice conditions. This prospective, clinical cohort study of Barcelona–Aromatase induced Bone Loss in Early breast cancer (B-ABLE) assessed BMD changes during 3 years of AI treatment in women with breast cancer. Patients with osteoporosis (T score < −2.5 or T score ≤ −2.0) and a major risk factor and/or prevalent fragility fractures were treated with oral bisphosphonates (BPs). Of 685 women recruited, 179 (26.1%) received BP treatment. By the third year of AI therapy, this group exhibited increased BMD in the lumbar spine (LS; 2.59%) and femoral neck (FN; 2.50%), although the increase was significant only within the first year (LS: 1.99% and FN: 2.04%). Despite BP therapy, however, approximately 15% of these patients lost more than 3% of their baseline bone mass. At 3 years, patients without BP experienced BMD decreases in the LS (−3.10%) and FN (−2.79%). In this group, BMD changes occurred during the first (LS: −1.33% and FN: −1.25%), second (LS: −1.19% and FN: −0.82%), and third (LS: −0.57% and FN: −0.65%) years of AI treatment. Increased BMD (>3%) was observed in just 7.6% and 10.8% of these patients at the LS and FN, respectively. Our data confirm a clinically relevant bone loss associated with AI therapy amongst nonusers of preventative BPs. We further report on the importance of BMD monitoring as well as calcium and 25-hydroxy vitamin D supplementation in these patients.

scholarly journals Profile of a Liver Transplant Follow-Up Clinic in a Nontransplant Canadian Urban Centre

1997 ◽  
Vol 11 (3) ◽  
pp. 235-238 ◽  
Author(s):  
R Bazylewski ◽  
BG Rosser ◽  
A Cohen ◽  
KDE Kaita ◽  
GY Minuk
Keyword(s):  
Liver Transplant ◽  
First Year ◽  
Transplant Recipients ◽  
Urban Centre ◽  
Care Clinic ◽  
Transplant Centre ◽  
Transplant Patients ◽  
Ambulatory Care Clinic ◽  
Liver Transplant Recipients

Care of the growing number of liver transplant recipients will increasingly fall on the referring centres. Thus, there is a need to define more clearly the demographic, clinical and laboratory profiles of liver transplant recipients, particularly in the setting of a centre where a liver transplantation program does not exist. The present study documented these features in 37 patients attending an adult ambulatory care clinic in an urban, nonliver transplant centre. Mean ± SD age of the study population was 44±11.9 years. Twenty-one patients (57%) were male. Annual enrolment in the clinic increased from three patients at the completion of the clinic's first year (1988) to 16 patients in the final year of the study (1993). Time between the transplantation procedure and the patient's return to the referring centre decreased from a mean of 12 weeks in 1988 to four weeks in 1993. During those seven years no patient required an unscheduled return to the transplant centre for surgical complications or problems associated with immunosuppressive therapy. In conclusion, these data provide a profile of liver transplant patients attending a nonliver transplant centre for follow-up and support the concept that nontransplant centres are capable of providing safe and, in terms of travel, less expensive care for liver transplant recipients.

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