Immunosuppressant-related hip pain after orthotopic liver transplant.
OBJECTIVE
Immunosuppressant-related hip pain can greatly affect a patient's mobility and increase the number of total hip arthroplasties. We investigated risk factors and causes of hip pain after orthotopic liver transplant.


METHODS
The medical records of 175 adult orthotopic liver transplant patients, who were followed-up for more than 2 years, were retrospectively reviewed. Data collected from the records included primary disease, medications, biochemical results, Child-Turcotte-Pugh score, death, rejection, and complications related to liver transplant.


RESULTS
A total of 11 patients (6.3%) complained of hip pain, which was diagnosed as calcineurin-inhibitor-induced pain syndrome in 4 patients (2.3%), osteonecrosis of the femoral head in 3 patients (1.7%), and osteoporosis in 2 patients (1.1%). The incidence of calcineurin-inhibitor-induced pain syndrome was related to the dosage of tacrolimus (P > .05) but independent of methylprednisolone use. The occurrence of osteonecrosis of the femoral head was independent of the dosage and early withdrawal of methylprednisolone (P > .05). Patients with methylprednisolone withdrawal within 6 months had significantly longer survival than those using methylprednisolone for more than 6 months (50 ± 15 vs 41 ± 18 mo; P = .007).


CONCLUSIONS
Calcineurin-inhibitor-induced pain syndrome and osteonecrosis of the femoral head are main causes of hip pain in adult orthotopic liver transplant patients. Osteonecrosis of the femoral head was not common, but the incidence of hip pain owing to calcineurin-inhibitor-induced pain syndrome was relatively high in orthotopic liver transplant patients. Early withdrawal of methylprednisolone could benefit the patients' survival.
Department of Hepatic Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Hua
H
Li
Ji-wen
JW
He
Bin-sheng
BS
Fu
Kun
K
Wang
Nan
N
Jiang
Guo-ying
GY
Wang
Jian
J
Zhang
Gen-shu
GS
Wang
Yang
Y
Yang
Gui-hua
GH
Chen
D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000139:chemically induced* / Q000453:epidemiology; D065095:Calcineurin Inhibitors; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008103:Liver Cirrhosis / Q000601:surgery; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000453:epidemiology; D010024:Osteoporosis / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects*
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone