Spine after solid organ transplantation in childhood: a clinical, radiographic, and magnetic resonance imaging analysis of 40 patients.
METHODS
A cross-sectional study of the spine in 40 young adults after solid organ transplantation in childhood.


OBJECTIVE
To evaluate the impact of organ transplantation and long-term immunosuppressive treatment on growing spine using magnetic resonance imaging (MRI).


BACKGROUND
A review of the current literature reveals no systematic evaluation of the spine after transplantation in childhood.


METHODS
A total of 40 adult patients (mean age 22.1 years, range, 16.0-27.0), who received either kidney, liver, or heart transplant as children, were evaluated. Mean follow-up after transplantation was 11.2 years (range 3.0-18.0). All patients filled in a questionnaire, underwent an interview and physical examination, as well as had MRI of the spine. Standing spinal radiographs were taken from patients with a rib hump > or = 6 degrees.


RESULTS
There were 8 (20%) patients who had a history of vertebral fracture. Eleven (28%) patients reported frequent back pain at rest. There were 15 (38%) patients who had scoliosis > 10 degrees (range 10 degrees -69 degrees ). On MRI, narrowed disc spaces were noted in 32 (80%) patients, and irregular endplates were noted in 24 (60%). There were 14 (35%) patients who had at least 1 compressed or wedged vertebra (> 20%). Patients treated for acute rejection had wedged vertebrae, speckled or black disc spaces, and irregular endplates more often than patients without rejections. Males had wedged vertebrae more often than females (P = 0.0067).


CONCLUSIONS
Back pain, scoliosis, wedged vertebrae, and narrowed, degenerated disc spaces are common after solid organ transplantation in childhood.
Helenius
Ilkka
I
Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. ilkka.helenius@helsinki.fi
Remes
Ville
V
Tervahartiala
Pekka
P
Salminen
Sari
S
Sairanen
Heikki
H
Holmberg
Christer
C
Palmu
Petri
P
Helenius
Miia
M
Peltonen
Jari
J
Jalanko
Hannu
H
D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000209:etiology / Q000503:physiopathology; D015519:Bone Density / Q000187:drug effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D011859:Radiography; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology; D013122:Spinal Diseases / Q000209:etiology* / Q000503:physiopathology; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology; D013168:Spondylolisthesis / Q000209:etiology / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology
D007166:Immunosuppressive Agents