Bone mass and mineral metabolism in liver transplant patients treated with FK506 or cyclosporine A.
The purpose of this study was to compare the effects of Cyclosporine A (CyA) and FK506 on bone mass and mineral metabolism in liver transplantation (LT) patients. A prospective study was performed on 18 male patients who underwent LT treated with CyA, and 7 LT patients who received FK506. Bone mineral density (BMD) of the lumbar spine and proximal femur (DPX-L) was measured before and at 6, 12, and 24 months after transplantation. Moreover, intact parathyroid hormone (PTH) and 25-hydroxyvitamin D (25OHD) levels were determined at the same time. The cumulative dose of glucocorticoids was calculated in all patients. At 6 months, lumbar BMD decreased 5.2 +/- 1.2% (P = 0.0005) and 2.9 +/- 2.1% (p = ns) in CyA and FK506 groups, respectively. Lumbar BMD reached baseline values at 1 year in the FK506 group and 2 years after LT in the CyA group. Moreover, significant intergroup differences in femoral neck BMD changes after 2 years of transplant were observed (CyA: -5.2 +/- 1.97 versus FK506: +1.55 +/- 2.2%; P = 0.039). In the first year posttransplant both groups showed a marked increase in PTH and 25OHD levels. The mean cumulative dose of glucocorticoids was higher in the CyA group (CyA group 11.06 +/- 0.46 g versus FK 506 group 6.71 +/- 0.42 g; P < 0.001), and multiple linear regression analysis showed a negative correlation between BMD changes at the lumbar spine and mean cumulative dose of glucocorticoids (P = 0.022). In conclusion, our data suggest that after liver transplantation treatment with FK506 shows a more favorable long-term effect on bone mass evolution than CyA therapy. These differences seem to be associated with the lower dose of glucocorticoids used in the FK506 group.
Monegal
A
A
Metabolic Bone Diseases Unit, Service of Rheumatology, ICAL, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain.
Navasa
M
M
Guañabens
N
N
Peris
P
P
Pons
F
F
Martínez de Osaba
M J
MJ
Rimola
A
A
Rodés
J
J
Muñoz-Gómez
J
J
D015502:Absorptiometry, Photon; D001379:Azathioprine / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects*; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D008297:Male; D010024:Osteoporosis / Q000139:chemically induced / Q000000981:diagnostic imaging; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000139:chemically induced; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D014807:Vitamin D / Q000097:blood
D007166:Immunosuppressive Agents; D010281:Parathyroid Hormone; D014807:Vitamin D; D016572:Cyclosporine; D001379:Azathioprine; D011241:Prednisone; D016559:Tacrolimus