Bone fractures in children undergoing orthotopic liver transplantation.
This retrospective study documents the incidence and distribution of fractures in 117 children with end-stage liver disease who underwent orthotopic liver transplantation (OLT) over a 6-year period (1987-1993). Both the pre- and post-OLT phases were included. Nineteen children (16.2 %) sustained a total of 69 fractures. Age at time of fracture ranged from 3 months to 9 years 8 months (median 13.5 months). There was no documented trauma in 14/19 cases. Metabolic bone disease, assessed qualitatively on plain radiographs, was present in 17/19 children at the time of fracture. This took the form of rickets (n = 3), osteopenia (n = 12) and osteosclerosis (n = 2). Potential risk factors including pre-existing metabolic bone disease, drugs and immobilization were assessed. The findings emphasise the need for clinical and radiological awareness of the fracture risk, particularly during the peri-transplant period when this risk may be greatest.
Hill
S A
SA
Department of Radiology, The Children's Hospital, Ladywood Middleway, Birmingham B16 8ET, UK.
Kelly
D A
DA
John
P R
PR
D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors
D007166:Immunosuppressive Agents