Therapy insight: orthopedic complications after solid organ transplantation in childhood.
Several factors, such as immobilization, metabolic bone disease and immunosuppressive drugs, can compromise the quality of bone in children who have undergone solid organ transplantation. In contrast to adults, decreased bone mineral density has been reported in only a small proportion of pediatric transplant patients, and the relationship between low bone mineral density and fracture risk has not been established in children. Nevertheless, fractures, scoliosis, and joint and spinal degeneration are common in patients who received solid organ grafts as children. Avascular bone necrosis occurs infrequently in this patient population. Future studies should evaluate the effects of the underlying disease, transplantation and immunosuppression on the metabolism of bone and cartilage. On the basis of our own clinical experience and literature review, the growing spine of children who have received transplants should be continuously evaluated, and follow-up of bone mineral density is indicated. By contrast, routine MRI of the joints seems unnecessary.
Helenius
Ilkka
I
Hospital for Children and Adolescents, Helsinki University Central Hospital, PO Box 281, 00029 HUS, Helsinki, Finland. ilkka.helenius@helsinki.fi
Jalanko
Hannu
H
Remes
Ville
V
Salminen
Sari
S
Sairanen
Heikki
H
Holmberg
Christer
C
Peltonen
Jari
J
D000367:Age Factors; D001416:Back Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D015519:Bone Density / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D011859:Radiography; D018570:Risk Assessment; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery
D007166:Immunosuppressive Agents