Donor Characteristics Contribute to Recipient Fracture Risk After Transplant

ASN: American Society of Nephrology Meeting

ASN: Donor Characteristics Contribute to Recipient Fracture Risk After Kidney Transplant

By Kate Johnson, Contributing Writer, MedPage Today
Published: November 11, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
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PHILADELPHIA, Nov. 11 -- Fractures in the first five years following kidney transplant can be predicted not only by the recipient's risk factors, but also by donor characteristics, researchers said here. Action Points
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Explain to interested patients that risk of fracture after kidney transplant depends on both recipient and donor characteristics.

Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Patients who received a kidney from a deceased donor were 30% more likely to fracture in the first five years compared with those who received a kidney from a living donor (P<0.001), Lucas Nikkel, a medical student at Pennsylvania State University told attendees at the American Society of Nephrology meeting.

HLA mismatch also conferred a greater risk of fracture (HR 1.09, P<0.014), Nikkel said.

"No large scale studies have yet examined the risk of all types of fractures, or the contribution of donor characteristics to the risk of fracture," he said, so he and his colleagues analyzed information on 68,814 kidney transplant recipients from the United States Renal Data System between 1988 and 1998.

In the five years following transplant there were 15,470 fractures (22.4%). "The majority were fairly minor, in the extremities," he explained, with foot and ankle fractures topping the list, followed by hand fractures and then femur fractures.

Cox proportional hazards models were used to quantify risk factors for fracture.

As expected, recipient characteristics such as age, gender, and race influenced the risk.

Recipients over 65 were significantly more likely to fracture than those under 45 (HR 1.69, P<0.001), as were females (HR 1.36, P<0.001), and Caucasians, compared with African-Americans (HR 1.27, P<0.001).

Those with co-morbid diabetes also had an increased risk of fracture compared with non-diabetic patients (HR 1.4, P<0.001), Nikkel noted, as did those who'd undergone pre-transplant dialysis (HR 1.08, P<0.001).

Patients who received more intense induction of immunosuppression -- defined as dual induction with both antibody and non-antibody based agents -- also had a greater risk compared with non-induction (HR 1.14, P<0.001), and single agent induction.

Taken together, the findings present physicians with a clarified picture of which transplant recipients face higher risk of fracture, said Nikkel. "It's something to look for in terms of screening patients who we need to warn about fractures, and in considering those to target with treatments to increase bone density in the future."

Nikkel acknowledged that a limitation of the study is the age of the data, "so aspects of the transplant procedure and immunosuppressant regimen that have changed in the ensuing years could not be evaluated."

However, he said "we believe our data still has value because it allowed us to get complete five-year follow-up on all our subjects."

Nikkel and his colleagues reported no financial conflicts.

http://www.medpagetoday.com/MeetingCoverage/ASN/11726