Evolution of bone disease after kidney transplantation: A prospective histomorphometric analysis of trabecular and cortical bone

Carvalho, Catarina; Magalhães, João; Pereira, Luíz Miguel; Simões-Silva, Liliana; Castro-Ferreira, Inês; Frazão, João

doi:10.1111/nep.12570

Cited by 16 publications

(15 citation statements)

References 27 publications

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“…Three bone biopsy studies in contemporary kidney transplant recipients were identified. The proportion of patients with high bone turnover in the present study confirms the findings of Neves et al, despite notable differences in case mix (20), but differs substantially from the studies of Evenepoel et al and Carvalho et al (21,27). Sex distribution, dialysis duration, and immunosuppressive therapy were comparable to those in Evenepoel et al (21), but our patients were slightly younger and had a greater proportion of diabetes.…”

Section: Discussionsupporting

confidence: 83%

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Changes in Bone Histomorphometry after Kidney Transplantation

Keronen

Martola

Finne

et al. 2019

CJASN

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Background: Over the past decade, the management of chronic kidney disease-mineral and bone disorder has changed substantially, altering the pattern of bone disease in chronic kidney disease. We aimed to evaluate the natural history of kidney bone disease in contemporary kidney transplant recipients and dialysis patients. Design, settings, participants, and measurement: Sixty-one dialysis patients referred to kidney transplantation participated in this prospective cohort study during November 2009 and December 2010. We performed baseline bone biopsies while the patients were on dialysis and repeated the procedure in 56 patients two years after kidney transplantation or two years after baseline if transplantation was not performed. Measurements of mineral metabolism and bone turnover as well as dual energy X-ray absorptiometry scans were obtained concurrently. Results: 37 of 56 participants received a kidney transplant, of which 27 underwent successful repeat bone biopsy. The proportion of patients with high bone turnover declined from 63% at baseline to 19% two years after kidney transplantation, while the proportion of those with low bone turnover increased from 26% to 52%. Of 19 participants remaining on dialysis after two years, 13 underwent successful repeat biopsy. The proportion of patients remaining on dialysis with high bone turnover decreased from 69% to 31%, and low bone turnover increased from 8% to 38%. Abnormal bone mineralization increased in transplant recipients from 33% to 44%, but decreased in patients remaining on dialysis from 46% to 15%. Trabecular bone volume showed little change after transplantation, but low bone volume increased in patients remaining on dialysis. Bone mineral density did not correlate with histomorphometric findings. Conclusions: Bone turnover decreased over time both in patients remaining on dialysis and in kidney transplant recipients. Bone mineral density and bone biomarkers were not associated with bone metabolism changes detected in bone biopsy.

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Section: Discussionsupporting

confidence: 83%

“…As previously noted (2,20,26,27), more than one-third of our transplanted patients presented with low trabecular bone volume at baseline and bone loss showed little change in the late kidney transplantation period despite the use of glucocorticoids. The proportion of dialysis patients with bone loss doubled in two years.…”

Section: Discussionsupporting

confidence: 82%

Changes in Bone Histomorphometry after Kidney Transplantation

Keronen

Martola

Finne

et al. 2019

CJASN

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“…Another possible explanation for the higher risk of vascular disease in patients with low PTH is post-transplant bone disease [ 19 ]. Bone biopsies early after renal transplantation show reduced activity of osteoblasts [ 20 ] and patients with low PTH pre-transplant show lower post-transplant osteoblastic activity [ 21 ]. This reduced cellularity and low bone turnover can develop into an adynamic state of the bone which diminishes the ability of the bone to buffer elevations in blood levels of phosphorus and calcium, which in turn leads to calcifications of soft tissue and vessels [ 22 ] and thereby a higher risk of vascular morbidity.…”

Section: Discussionmentioning

confidence: 99%

Is low pre-transplant parathyroid hormone a risk marker for cardiovascular disease in long-term follow-up of renal transplant recipients?

et al. 2018

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BackgroundSecondary hyperparathyroidism and altered levels of parathyroid hormone (PTH) are associated with vascular events in chronic kidney disease. After renal transplantation, this association is not clear. Pre-transplant parathyroidectomy (PTX) is common, but post-transplant data are scarce. We aimed to study the effect of PTH at the time of transplantation on risk of post-transplant vascular events in renal transplant recipients with and without pre-transplant PTX.Methods258 patients from two Swedish transplant units were followed for 6 years. Separate analyses were made for patients with or without pre-transplant PTX. Patients with no pre-transplant PTX were stratified by quartiles of PTH at time of transplantation and patients with pre-transplant PTX were stratified by above and below median levels of PTH at time of transplantation. Hazard ratios for vascular events, mortality, and graft failure were calculated in adjusted Cox regression models.ResultsIn patients with no pre-transplant PTX, the lowest quartile of PTH at transplantation had a higher risk of cardiovascular events compared to quartile 3 with an adjusted hazard ratio (95% CI) of 2.63 (1.04–6.67). In patients with pre-transplant PTX, the group below median of PTH had a higher risk of cardiovascular events with an adjusted hazard ratio (95% CI) of 18.15 (1.62–203.82) compared to patients above median of PTH.ConclusionLow levels of parathyroid hormone before transplantation were associated with increased risk of post-transplant vascular events both in patients with and without pre-transplant parathyroidectomy. Any conclusions on causal or direct effect of PTH on outcome cannot be drawn from this observational study.

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“…The technique was optimized in our lab 76 using an exothermic process. One of the disadvantages of the procedure is the inability to perform immunohistochemistry studies due to loss of antigenicity, which is worth exploring in future works.…”

Section: Discussionmentioning

confidence: 99%

“…Femurs were dehydrated in 100% ethanol for 3 days, at 4 °C, followed by immersion in xylol for 24 h and further embedding in methylmethacrylate and processed for histological analysis as described elsewhere 76, 82 .…”

Section: Methodsmentioning

confidence: 99%

Injectable hybrid system for strontium local delivery promotes bone regeneration in a rat critical-sized defect model

Lourenço

Nevès

Ribeiro-Machado

et al. 2017

Sci Rep

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Strontium (Sr) has been described as having beneficial influence in bone strength and architecture. However, negative systemic effects have been reported on oral administration of Sr ranelate, leading to strict restrictions in clinical application. We hypothesized that local delivery of Sr improves osteogenesis without eliciting detrimental side effects. Therefore, the in vivo response to an injectable Sr-hybrid system composed of RGD-alginate hydrogel cross-linked in situ with Sr and reinforced with Sr-doped hydroxyapatite microspheres, was investigated. The system was injected in a critical-sized bone defect model and compared to a similar Sr-free material. Micro-CT results show a trend towards higher new bone formed in Sr-hybrid group and major histological differences were observed between groups. Higher cell invasion was detected at the center of the defect of Sr-hybrid group after 15 days with earlier bone formation. Higher material degradation with increase of collagen fibers and bone formation in the center of the defect after 60 days was observed as opposed to bone formation restricted to the periphery of the defect in the control. These histological findings support the evidence of an improved response with the Sr enriched material. Importantly, no alterations were observed in the Sr levels in systemic organs or serum.

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Evolution of bone disease after kidney transplantation: A prospective histomorphometric analysis of trabecular and cortical bone

Abstract: The results show a reduction in bone activity, suggesting increased risk of adynamic bone and loss of bone volume. Cortical bone seems less affected by post-transplant biological changes in the first years after kidney transplantation.

Cited by 16 publications

References 27 publications

Changes in Bone Histomorphometry after Kidney Transplantation

Changes in Bone Histomorphometry after Kidney Transplantation

Is low pre-transplant parathyroid hormone a risk marker for cardiovascular disease in long-term follow-up of renal transplant recipients?

Injectable hybrid system for strontium local delivery promotes bone regeneration in a rat critical-sized defect model

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