Risk of fractures after renal transplantation in the United States.
BACKGROUND
Although it is known that the incidence of fracture events is increased in renal transplantation recipients, the timing and the factors associated with risk of fractures are less well understood. The objective of this study was to estimate the time to fracture in renal transplantation recipients and to determine whether risk was associated with patient and transplantation characteristics.


METHODS
Using the U. S. Renal Data System, we retrospectively studied 68,814 patients, who underwent renal transplantation between 1988 and 1998. Fractures were identified from International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes in billing data. Time to first fracture was modeled during the first 5 years posttransplant using the Kaplan-Meier method and Cox proportional hazards models.


RESULTS
Of the patients who underwent transplantation, 22.5% developed a fracture within 5 years. Woman (hazard ratio [HR] 1.36, P<0.0001), patients older than 45 years of age (HR 1.14, P<0.0001) especially older than 65 years (HR 1.69, P<0.0001), and whites (HR 1.28, P<0.0001) were at increased risk of a fracture. Additionally, receipt of a deceased donor kidney (HR 1.30, P<0.0001), increased human leukocyte antigen mismatches (HR 1.09, P<0.014), diabetes (HR 1.88, P<0.0001), pretransplant dialysis (HR 1.08, P<0.0001), and an aggressive induction immunosuppression regimen (HR 1.14, P<0.0001) all significantly increased risk of fracture events during the first 5 years.


CONCLUSIONS
In addition to patient demographic features, donor factors, including suboptimal organ quality and the need for more intense immunosuppression, were associated with an increased risk of fractures during the first 5 years after a renal transplant.
Nikkel
Lucas E
LE
Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA.
Hollenbeak
Christopher S
CS
Fox
Edward J
EJ
Uemura
Tadahiro
T
Ghahramani
Nasrollah
N
D000328:Adult; D015992:Body Mass Index; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D006680:HLA Antigens; D007166:Immunosuppressive Agents; D008775:Methylprednisolone