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Bone mineral density (BMD), T score and prevalence of osteopenia* and osteoporosis † at the lumbar spine (L1-4), femoral neck and total hip
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BackgroundOsteopenia and bone loss are major complications after renal transplantation. Clinical data in the Asian population are lacking.MethodsWe prospectively studied the changes in bone mineral density (BMD) of 31 cadaveric renal allograft recipients using dual energy X-ray absorptiometry (DEXA) within 2 weeks after transplantation and then at...
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AIM
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METHODS
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Objective
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Background
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Citations
Introduction: Despite major advances in kidney transplant, glucocorticoids (GCs) or steroids remain one of the mainstay treatments. They possess adverse events (AEs) that are related to cumulative dosage, as documented in experimental and clinical studies. Therefore, it is important to comprehend and interpret experimental data and equally important to critically review clinical studies.
Areas covered: This article provides a broad overview of the structure, pharmacokinetics, and pharmacodynamics of systemically administered GCs in transplant setting. It further discusses at length the results of in vitro and pre-clinical studies, as well as steroid avoidance (SA) or withdrawal (SW)-based clinical studies. We summarized the main AEs and discussed the alternatives to minimize these events. Some clinically relevant drug-drug interactions are also highlighted.
Expert Opinion: Although SA/SW in kidney transplant is a desirable strategy due to its AEs, there is no evidence to support that strategy based on the available data, despite some encouraging reports. Furthermore, early diagnosis and treatment of GC-induced AEs seem to be the most efficacious strategies. Likewise, some risks factors predate transplant and could be used to risk-stratify patients to determine appropriate risk-reduction strategies. Additional randomized-controlled studies are required to assess the impact of SA/SW during short and long follow-ups.
To evaluate the pattern of immunosuppressive drug adverse reactions in adult kidney transplant recipients in Iran.
Adult kidney transplant outpatients under immunosuppressive therapy were recruited into the study. All adverse drug reactions to immunosuppressants and their relevant clinical and paraclinical characteristics were recorded. Causality assessment was performed by the Naranjo algorithm. The seriousness of adverse drug reactions was determined by the World Health Organization definition. The Schumock and Thornton questionnaire was used to assess the preventability of adverse drug reactions. Statistical analyses were performed.
A total of 1100 adverse drug reactions were detected from 120 kidney transplant recipients. Increased appetite (9.09%) was the adverse reaction reported most frequently. Causality assessment revealed that 1019 adverse drug reactions (92.64%) were possible. Forty adverse drug reactions (3.64%) were identified as serious. Six hundred seventy-one adverse drug reactions (61%) were preventable. Posttransplant duration was significantly correlated with the number of adverse drug reactions (R=0.19; P = .035).
All renal allograft recipients experienced at least 1 immunosuppressant-related adverse reaction. Prolongation of immunosuppressive treatment resulted in an increase in adverse drug reactions.
Limited data are available regarding patterns of bone loss in South East Asian renal transplant patients. We aimed to determine the prevalence of low bone density and factors contributing to bone loss in Singaporean patients in the first year after renal transplant.
Seventy-nine consecutive patients who underwent renal transplant were evaluated. Bone mineral density (BMD) was evaluated at 0 (baseline), and at 6 and 12 months after transplant. Baseline parathyroid hormone and vitamin D levels were also assessed. Multivariate regression models were used to investigate the relationship between the different variables and BMD.
Thirty-six patients (45.6%) had low BMD at baseline. Factors correlating with the low BMD were older age, postmenopausal status, and tertiary hyperparathyroidism (P<0.0005, 0.009, and 0.027, respectively). There was a linear decrease in total hip and lumbar spine BMD from baseline to 12 months, the decrease from baseline to 6 months being significant (P=0.019 for total hip and P<0.0005 for lumbar spine). Patients with tertiary hyperparathyroidism had a greater risk of decrease in BMD at 6 months compared with patients with secondary hyperparathyroidism (odds ratio=13.5, confidence interval: 1.3, 144.4) and with those who had parathyroidectomy (odds ratio=34.9; confidence interval: 2.0, 598.8).
The prevalence of low BMD in this population of renal transplant recipients was high. Parathyroid status was the only independent factor that correlated with low BMD at baseline and subsequent bone loss highlighting the critical role of this hormone in bone metabolism after renal transplant.
