title: Hospitalized avascular necrosis after renal transplantation in the United States.
abstract: BACKGROUND
  The national incidence of and risk factors for hospitalized avascular necrosis (AVN) in renal transplant recipients has not been reported.
  
  
  METHODS
  This historical cohort study consisted of 42,096 renal transplant recipients enrolled in the United States Renal Data System (USRDS) between 1 July 1994 and 30 June 1998. The data source was USRDS files through May 2000. Associations with hospitalizations for a primary diagnosis of AVN (ICD-9 codes 733.4x) within three years after renal transplant were assessed in an intention-to-treat design by Cox regression analysis.
  
  
  RESULTS
  Recipients had a cumulative incidence of 7.1 episodes/1000 person-years from 1994 to 1998. The two-year incidence of AVN did not change significantly over time. Eighty-nine percent of the cases of AVN were due to AVN of the hip (733.42) and 60.2% of patients with AVN underwent total hip arthroplasty (THA); these percentages did not change significantly over time. In the Cox regression analysis, an earlier year of transplant, African American race [adjusted hazard ratio (AHR), 1.65, 95% confidence interval (CI) 1.33 to 2.03], allograft rejection (AHR 1.67, 95% CI 1.35 to 2.07), peritoneal dialysis (vs. hemodialysis; AHR 1.44, 95% CI 1.15 to 1.81), and diabetes (AHR 0.41, 95% CI 0.27 to 0.64) were the only factors independently associated with hospitalizations for AVN.
  
  
  CONCLUSIONS
  The incidence of AVN did not decline significantly over time in the renal transplant population. Patients with allograft rejection, African American race, peritoneal dialysis and earlier date of transplant were at the highest risk of AVN, while diabetic recipients were at a decreased risk.
authors.affiliation: Nephrology Service and Rheumatology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. kevin.abbott@na.amedd.army.nil
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Oglesby
authors.forename: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
mesh_terms: D000328:Adult; D044383:Black People; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010020:Osteonecrosis / Q000453:epidemiology* / Q000209:etiology; D010530:Peritoneal Dialysis; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D001741:Black or African American