Changes in calcium homoeostasis in patients undergoing liver transplantation: effects of a single infusion of pamidronate administered pre-operatively.
Bone turnover, bone loss and fracture risk increase after liver transplantation. It has been postulated that peri-operative administration of a bisphosphonate might prevent bone loss and reduce fracture rate. We studied the effects of a single pre-operative dose of pamidronate on biochemical parameters of skeletal metabolism in the first month after liver transplantation. In a randomized, single-blind study, six of 12 patients with chronic liver disease received 60 mg of pamidronate intravenously on a single occasion 1-30 days before transplantation. Six other patients undergoing transplantation received no pamidronate. We measured serum calcium, phosphate, albumin, bone-specific alkaline phosphatase, plasma parathyroid hormone and tartrate-resistant acid phosphatase before pamidronate infusion and at frequent intervals during the first 30 post-operative days. In treated patients, plasma parathyroid hormone increased 12-fold over baseline values and remained elevated in comparison with baseline at days 26-30; serum calcium and phosphate fell significantly, returning to normal at around day 14 post-operatively. There were no significant changes in any parameter in the untreated group. No changes in bone formation or resorption markers were observed in either group. The large increase in plasma parathyroid hormone concentrations in the treated group is probably secondary to the fall in serum calcium. The magnitude of the increase is much greater than that seen after pamidronate infusion in other patient groups. The lack of change in, or correlation of, serum calcium and plasma parathyroid hormone in the untreated group suggests that additional factors release calcium from bone after liver transplantation, presumably by increasing bone resorption.
University of Cambridge Department of Medicine, Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, U.K.
N J
NJ
Bishop
M
M
Ninkovic
G J
GJ
Alexander
S D
SD
Holmes
T
T
Milligan
C
C
Price
J E
JE
Compston
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001862:Bone Resorption / Q000097:blood / Q000517:prevention & control*; D002118:Calcium / Q000097:blood*; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010012:Osteogenesis / Q000187:drug effects; D000077268:Pamidronate; D010281:Parathyroid Hormone / Q000097:blood; D010710:Phosphates / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011300:Preoperative Care; D016037:Single-Blind Method
D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone; D010710:Phosphates; D000077268:Pamidronate; D002118:Calcium