Immunosuppressant-Related Hip Pain After Orthotopic Liver Transplant

Abstract

Objectives: Immunosuppressant-related hip pain can greatly affect a patient's mobility and increase the number of total hip arthroplasties. We investigated risk factors and causes of hip pain after orthotopic liver transplant. Materials and Methods:The medical records of 175 adult orthotopic liver transplant patients, who were followed-up for more than 2 years, were retrospectively reviewed. Data collected from the records included primary disease, medications, biochemical results, Child-Turcotte-Pugh score, death, rejection, and complications related to liver transplant. Results: A total of 11 patients (6.3%) complained of hip pain, which was diagnosed as calcineurininhibitor-induced pain syndrome in 4 patients (2.3%), osteonecrosis of the femoral head in 3 patients (1.7%), and osteoporosis in 2 patients (1.1%). The incidence of calcineurin-inhibitorinduced pain syndrome was related to the dosage of tacrolimus (P > .05) but independent of methylprednisolone use. The occurrence of osteonecrosis of the femoral head was independent of the dosage and early withdrawal of methylprednisolone (P > .05). Patients with methylprednisolone withdrawal within 6 months had significantly longer survival than those using methylprednisolone for more than 6 months (50 ± 15 vs 41 ± 18 mo; P = .007). Conclusions: Calcineurin-inhibitor-induced pain syndrome and osteonecrosis of the femoral head are main causes of hip pain in adult orthotopic liver transplant patients. Osteonecrosis of the femoral head was not common, but the incidence of hip pain owing to calcineurin-inhibitor-induced pain syndrome was relatively high in orthotopic liver transplant patients. Early withdrawal of methylprednisolone could benefit the patients' survival.

Bone mineral density following liver transplantation: a 10-year trend analysis

“…This wide variation was likely due to differences in surveillance methodology and patient type. For example, the osteoporosis incidence in a study with sporadic surveillance [13] was only 1.1%, whereas a study with regular surveillance by Bjoro et al reported 65.1% [8]. In the case of patient type, patients with cholestatic liver disease were reported to have poorer BMD than patients with non-cholestatic liver disease [8].…”

Calcineurin inhibitor-induced pain syndrome (CIPS) affects the hips in a renal transplant recipient: A case report

“…To the best of our knowledge, all previous case reports, and reviews of CIPS in patients who have undergone renal transplantation involved bones around the knees or feet [ [12] , [13] , [14] ]. However, Li et al reported the incidence of CIPS in 4 out of 11 patients presenting with hip pain following liver transplantation [ 15 ].…”

Bone infarction of the hip after hand allotransplantation: A case report

“…Studies have demonstrated that less than 4% patients of AVN patients who underwent renal transplantation, 6.3% patients of AVN patients following cardiac transplantation, and 2% of patients following liver transplantation exhibit osteonecrosis of the hip (Hedri et al, 2007;Lieberman, Roth, Elsissy, Dorey, & Kobashigawa, 2008;Schmitt-Sody et al, 2008). The most commonly reported organ transplantation-induced AVN is caused by long-term administration of corticosteroid therapy (Li et al, 2013). However, the present study described a case in which AVN was induced following high-dosage and short-term systemic cor- The case presented here is the second case to develop bilateral AVN after hand transplantation.…”