Avascular necrosis of bone as a complication of renal transplantation

ENAL TRANSPLANTATION has been increasingly successful, especially with new tissue typing techniques and effective immunosuppressive control. The musculoskeletal complications observed after renal transplantation have included arthralgias, synovitis, septic arthritis, myalgias, and avascular necrosis. Avascular necrosis has been the most prevalent and disturbing problem. The disability and morbidity occurring as a result of this complication has ranged from mild to severe. This lesion is at present the most common long-term disability in patients surviving for more than 1 yr who are otherwise well with stable renal function.6 There have been no planned studies showing a causal relationship between immunosuppressive therapy and development of avascular necrosis but the association is highly suggestive. There has been no causal relationship with the type of donor kidney used, living or cadaveric, with pre- or post-transplantation dialysis or with the number of rejection crises. ‘5,35 A review of the reported cases of avascular necrosis post renal transplantation, as listed in Table 1, shows the incidence to range between 1.4% and 16.9%. With attempts to decrease the total dosage of corticosteroid, the percentage of cases developing this complication should decrease significantly.