Bone Loss and Fracture After Lung Transplantation1

Shane, Elizabeth; Papadopoulos, Anastasio; Staron, Ronald B.; Addesso, Vicki; Donovan, Daniel S.; McGregor, Carlton C.; Schulman, Larry L.

doi:10.1097/00007890-199907270-00010

Cited by 109 publications

(46 citation statements)

References 32 publications

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“…Interestingly, the prevalence of morbidities related to immunosuppression in our 10-year survivors did not exceed that reported in patients earlier in the post-transplant course probably as a result of more intense immunosuppression in the early post-transplant period (14,(16)(17)(18)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 44%

Functional Status and Quality of Life in Patients Surviving 10 years After Lung Transplantation

Rutherford¹,

Fisher²,

Hilton³

et al. 2005

Am J Transplant

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Although many lung allograft recipients achieve longterm survival, there is a lack of published data regarding these patients' functional status and quality of life (QoL). We evaluated all 10-year survivors at our institution and, utilizing the SF-36 questionnaire, compared their QoL to population normative and chronic illness data. Twenty-eight (29%) of 96 patients survived ≥10 years following 11 single, 6 bilateral and 11 heartlung procedures. At the most recent evaluation, median FEV 1 in single and double lung recipients was predicted to be 54% and 74%, respectively. Five (18%) patients had BOS score 0, 13 (46%) BOS 1, 5 (18%) BOS 2 and 5 (18%) BOS 3 and median time to BOS was 7 years. Four (14%) patients required renal replacement therapy. Three patients (11%) developed symptomatic osteoporosis, 2 (7%) post-transplant lymphoma and 1 (4%) an ischaemic stroke. Scores for physical function, role-physical/emotional and general health, but not mental health and bodily pain, were significantly lower compared to normative and chronic illness data. Energy and social-function scores were significantly lower than normative data alone. Long-term survival after lung transplantation is characterized by an absence or delayed development of BOS, low iatrogenic morbidity and preserved mental, but reduced physical health status.

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Section: Discussionmentioning

confidence: 44%

Functional Status and Quality of Life in Patients Surviving 10 years After Lung Transplantation

Rutherford¹,

Fisher²,

Hilton³

et al. 2005

Am J Transplant

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“…43 Finally, the higher rates of fracture following cardiac and lung transplantation, for which higher doses of glucocorticoids are generally used, would be consistent for a pathogenetic role of glucocorticoids. 19,44,45 Other Immunosuppressive Agents A number of immunosuppressive agents used in transplantation have been shown to have adverse effects on bone in rodents, inducing a high turnover state and reducing bone mass; these include cyclosporine A, tacrolimus and cyclosporine G. 46 The effects of these agents in humans are difficult to study because these drugs are so rarely used in isolation and usually against a background of disease that itself affects bone remodelling, but small studies indicate similar effects in humans to those observed in rats. 47,48 More recently developed immunosuppressive agents include sirolimus and mycophenylate mofetil.…”

Section: Glucocorticoidsmentioning

confidence: 99%

Osteoporosis after liver transplantation

Compston

2003

Liver Transplantation

107

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L iver transplantation is now a well-established procedure with 5-year survival rates of over 70% in most centers. 1 The quality of life for the majority of survivors is good, but a number of long-term complications have been described, many of which are related to immunosuppressive therapy. The main skeletal complications are avascular necrosis and osteoporosis, of which the latter is most common and may result in significant morbidity and mortality.Studies performed early in the history of liver transplantation documented rapid bone loss and a high incidence of fragility fractures, but there is evidence that the frequency of osteoporosis after transplantation may be decreasing, providing important insights into its pathogenesis. This review considers the clinical features, pathogenesis, pathophysiology, and management of osteoporosis after liver transplantation and considers the lessons that may be learnt from changes in its natural history. Clinical FeaturesOsteoporosis is characterised by reduced bone mass and disruption of bone architecture, leading to decreased bone strength and an increase in the risk of fragility fracture particularly at the wrist, hip and spine. 2 These fractures are associated with a high morbidity and increased mortality and often have devastating effects on quality of life.

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“…We have previously reported that steroid withdrawal in patients who have undergone a successful liver transplant accelerates the recovery of lumbar spine bone density without adverse effects on graft tolerance (Martínez Díaz-Guerra et al, 2002). Moreover, higher rates of fracture occurring after cardiac and lung (Shane et al, 1999) transplantation, in which higher doses of steroids are use, would be consistent with their role in the pathogenesis of post transplant osteoporosis. The late phase observed in the postrasplant period takes place when the glucocorticoid doses are usually tapered below 5 mg per day.…”

Section: Related To Transplantation: Immunossupressor Drugs and Othermentioning

confidence: 70%

Post-Transplantation Bone Disease

Hawkins¹,

Guadalix²,

Sanchez³

et al. 2012

Osteoporosis

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Bone Loss and Fracture After Lung Transplantation1

Abstract: We conclude that fractures are a significant problem in the first year after lung transplantation, even in patients who receive therapy to prevent bone loss. Women with low pretransplantation BMD and a history of pretransplantation glucocorticoid therapy are at greatest risk.

Cited by 109 publications

References 32 publications

Functional Status and Quality of Life in Patients Surviving 10 years After Lung Transplantation

Functional Status and Quality of Life in Patients Surviving 10 years After Lung Transplantation

Osteoporosis after liver transplantation

Post-Transplantation Bone Disease

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