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Aseptic Necrosis After Renal Transplantation in Children

Aseptic Necrosis After Renal Transplantation in Children Abstract • Aseptic necrosis developed in 11 (6%) of 171 recipients of renal allografts who underwent transplant operations at Childrens Hospital of Los Angeles between February 1967 and August 1977. Pain was the predominant presenting symptom and preceded roentgenographic evidence of aseptic necrosis by as long as seven months. Initial symptoms occurred two months to four years posttransplant. Limited weight bearing and reduction in the dosage of prednisone failed to prevent the progressive destruction of five femoral heads in three patients. Hip replacement led to an amelioration of the symptoms and a resumption of normal activity in each patient. Two patients with involvement of multiple osseous structures have persistent knee and elbow joint pain and effusions, and one of them has required prosthetic replacement of the proximal humerus. No therapy was required for patients with aseptic necrosis of single bones of the hand and foot. There was no statistically significant difference in the total steroid dose received during the first posttransplant year between patients in whom aseptic necrosis developed, and those in whom it did not develop. (Am J Dis Child 132:765-767, 1978) References 1. Briggs WA, Hampers CL, Merrill JP, et al: Aseptic necrosis in the femur after renal transplantation . Ann Surg 175:282-289, 1972.Crossref 2. Griffiths HJ, Ennis JT, Bailey G: Skeletal changes following renal transplantation . Radiology 113:621-626, 1974.Crossref 3. Chatterjee SN, Friedler RM, Berne TV, et al: Persistent hypercalcemia after successful renal transplantation . Nephron 17:1-7, 1976.Crossref 4. Bell PRF, Briggs JD, Kyle K, et al: Renal transplantation: An analysis of 33 cases . Br Med J 4:408-413, 1972.Crossref 5. Bravo JF, Herman JH, Smyth CJ: Musculoskeletal disorders after renal homotransplantation . Ann Intern Med 66:87-104, 1967.Crossref 6. Cruess RL, Blennerhassett J, MacDonald FR. et al: Aseptic necrosis following renal transplantation . J Bone Joint Surg [Am] 50:1577-1589, 1968. 7. Elmore SM: Bone problems related to renal transplantation . Transplant Proc 4:687-688, 1972. 8. Eremin J, Swaney WE, Marshall VC, et al: Avascular necrosis in cadaveric renal allografts . J Surg 39:41-46, 1969. 9. Evarts CM, Phalen GS: Osseous avascular necrosis associated with renal transplantation . Clin Orthop 78:330-335, 1971.Crossref 10. Hall MC, Elmore SM, Bright RW, et al: Skeletal complications in a series of human renal allografts . JAMA 208:1825-1829, 1969.Crossref 11. Harrington KD, Murray WR, Kountz SL, et al: Avascular necrosis of bone after renal transplantation . J Bone Joint Surg [Am] 53:203-215, 1969. 12. Murray WR: Hip problems associated with organ transplants . Clin Orthop 90:57-69, 1973. 13. Pierides AM, Simpson W, Stainsby D, et al: Avascular necrosis of bone following renal transplantation . Q J Med 175:459-480, 1975. 14. Smyth CJ, Leidholt JD: Steroid arthropathy of the hip . Clin Orthop 90:50-56, 1973. 15. Troch T, Rombouts JJ, van Ypersele de Strihou C, et al: Epiphyseal osteonecrosis in transplanted patients: Effect of surgical treat ment . Proc EDTA 9:376-387, 1972. 16. Velayos EE, Leidholt JD, Smyth CJ, et al: Arthropathy associated with steroid therapy . Ann Intern Med 64:759-771, 1966.Crossref 17. Yadav RVS, Marshall VC, Johnson W, et al: Cadaveric renal transplantation: Long-term survival . Med J Aust 1:729-733, 1972. 18. Bewick M, Stewart PH, Rudge C, et al: Avascular necrosis of bone in patients undergoing renal allotransplantation . Clin Nephrol 5:66-72, 1976. 19. Jone JP, Engleman EP, Najarian JS: Systemic fat embolism after renal homotransplantation and treatment with corticosteroids . N Engl J Med 273:1453-1458, 1965.Crossref 20. Najarian JS, Simmons RL, Tallent MB, et al: Renal transplantation in infants and children . Ann Surg 174:583-601, 1971.Crossref 21. McEnery PT, Gonzalez LL, Martin LW, et al: Growth and development of children with renal transplants: Use of alternate-day steroid therapy . J Pediatr 83:806-814, 1973.Crossref 22. Williams GM, Lee HM, Hume DM: Renal transplants in children . Transplant Proc 1:262-266, 1969. 23. Lilly JR, Giles G, Hurwitz R, et al: Renal homotransplantation in pediatric patients . Pediatrics 47:548-557, 1971. 24. Hulme B, Kenyon JR, Owen K, et al: Renal transplantation in children: Analysis of 25 consecutive transplants in 19 recipients . Arch Dis Child 47:486-494, 1972.Crossref 25. Belzer FO, Schweitzer TR, Holliday M, et al: Renal homotransplantation in children . Am J Surg 124:270-278, 1972.Crossref 26. Fine RN: Renal transplantation in children . Adv Nephrology 5:201-227, 1975. 27. Fisher DE, Bickel WH: Corticosteroid-induced avascular necrosis . J Bone Joint Surg 53:859-873, 1971. 28. Fisher DE, Bickel WH, Holley KE: Histologic demonstration of fat emboli in aseptic necrosis associated with hypercortisonism . Mayo Clin Proc 44:252-259, 1969. 29. Pennisi AJ, Fiedler J, Mickey R, et al: Hyperlipidemia in pediatric renal allograft recipients . J Pediatr 87:249-251, 1975.Crossref 30. Cole WG, Neal BW: Corticosteroids and avascular necrosis of the femoral head in childhood . Aust Paediatr J 12:37-42, 1976. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1978.02120330037009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Aseptic necrosis developed in 11 (6%) of 171 recipients of renal allografts who underwent transplant operations at Childrens Hospital of Los Angeles between February 1967 and August 1977. Pain was the predominant presenting symptom and preceded roentgenographic evidence of aseptic necrosis by as long as seven months. Initial symptoms occurred two months to four years posttransplant. Limited weight bearing and reduction in the dosage of prednisone failed to prevent the progressive destruction of five femoral heads in three patients. Hip replacement led to an amelioration of the symptoms and a resumption of normal activity in each patient. Two patients with involvement of multiple osseous structures have persistent knee and elbow joint pain and effusions, and one of them has required prosthetic replacement of the proximal humerus. No therapy was required for patients with aseptic necrosis of single bones of the hand and foot. There was no statistically significant difference in the total steroid dose received during the first posttransplant year between patients in whom aseptic necrosis developed, and those in whom it did not develop. (Am J Dis Child 132:765-767, 1978) References 1. Briggs WA, Hampers CL, Merrill JP, et al: Aseptic necrosis in the femur after renal transplantation . Ann Surg 175:282-289, 1972.Crossref 2. Griffiths HJ, Ennis JT, Bailey G: Skeletal changes following renal transplantation . Radiology 113:621-626, 1974.Crossref 3. Chatterjee SN, Friedler RM, Berne TV, et al: Persistent hypercalcemia after successful renal transplantation . Nephron 17:1-7, 1976.Crossref 4. Bell PRF, Briggs JD, Kyle K, et al: Renal transplantation: An analysis of 33 cases . Br Med J 4:408-413, 1972.Crossref 5. Bravo JF, Herman JH, Smyth CJ: Musculoskeletal disorders after renal homotransplantation . Ann Intern Med 66:87-104, 1967.Crossref 6. Cruess RL, Blennerhassett J, MacDonald FR. et al: Aseptic necrosis following renal transplantation . J Bone Joint Surg [Am] 50:1577-1589, 1968. 7. Elmore SM: Bone problems related to renal transplantation . Transplant Proc 4:687-688, 1972. 8. Eremin J, Swaney WE, Marshall VC, et al: Avascular necrosis in cadaveric renal allografts . J Surg 39:41-46, 1969. 9. Evarts CM, Phalen GS: Osseous avascular necrosis associated with renal transplantation . Clin Orthop 78:330-335, 1971.Crossref 10. Hall MC, Elmore SM, Bright RW, et al: Skeletal complications in a series of human renal allografts . JAMA 208:1825-1829, 1969.Crossref 11. Harrington KD, Murray WR, Kountz SL, et al: Avascular necrosis of bone after renal transplantation . J Bone Joint Surg [Am] 53:203-215, 1969. 12. Murray WR: Hip problems associated with organ transplants . Clin Orthop 90:57-69, 1973. 13. Pierides AM, Simpson W, Stainsby D, et al: Avascular necrosis of bone following renal transplantation . Q J Med 175:459-480, 1975. 14. Smyth CJ, Leidholt JD: Steroid arthropathy of the hip . Clin Orthop 90:50-56, 1973. 15. Troch T, Rombouts JJ, van Ypersele de Strihou C, et al: Epiphyseal osteonecrosis in transplanted patients: Effect of surgical treat ment . Proc EDTA 9:376-387, 1972. 16. Velayos EE, Leidholt JD, Smyth CJ, et al: Arthropathy associated with steroid therapy . Ann Intern Med 64:759-771, 1966.Crossref 17. Yadav RVS, Marshall VC, Johnson W, et al: Cadaveric renal transplantation: Long-term survival . Med J Aust 1:729-733, 1972. 18. Bewick M, Stewart PH, Rudge C, et al: Avascular necrosis of bone in patients undergoing renal allotransplantation . Clin Nephrol 5:66-72, 1976. 19. Jone JP, Engleman EP, Najarian JS: Systemic fat embolism after renal homotransplantation and treatment with corticosteroids . N Engl J Med 273:1453-1458, 1965.Crossref 20. Najarian JS, Simmons RL, Tallent MB, et al: Renal transplantation in infants and children . Ann Surg 174:583-601, 1971.Crossref 21. McEnery PT, Gonzalez LL, Martin LW, et al: Growth and development of children with renal transplants: Use of alternate-day steroid therapy . J Pediatr 83:806-814, 1973.Crossref 22. Williams GM, Lee HM, Hume DM: Renal transplants in children . Transplant Proc 1:262-266, 1969. 23. Lilly JR, Giles G, Hurwitz R, et al: Renal homotransplantation in pediatric patients . Pediatrics 47:548-557, 1971. 24. Hulme B, Kenyon JR, Owen K, et al: Renal transplantation in children: Analysis of 25 consecutive transplants in 19 recipients . Arch Dis Child 47:486-494, 1972.Crossref 25. Belzer FO, Schweitzer TR, Holliday M, et al: Renal homotransplantation in children . Am J Surg 124:270-278, 1972.Crossref 26. Fine RN: Renal transplantation in children . Adv Nephrology 5:201-227, 1975. 27. Fisher DE, Bickel WH: Corticosteroid-induced avascular necrosis . J Bone Joint Surg 53:859-873, 1971. 28. Fisher DE, Bickel WH, Holley KE: Histologic demonstration of fat emboli in aseptic necrosis associated with hypercortisonism . Mayo Clin Proc 44:252-259, 1969. 29. Pennisi AJ, Fiedler J, Mickey R, et al: Hyperlipidemia in pediatric renal allograft recipients . J Pediatr 87:249-251, 1975.Crossref 30. Cole WG, Neal BW: Corticosteroids and avascular necrosis of the femoral head in childhood . Aust Paediatr J 12:37-42, 1976.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Aug 1, 1978

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