title: Charcot neuroarthropathy after simultaneous pancreas-kidney transplant.
abstract: BACKGROUND
  Immunosuppressive regimen is associated with several metabolic adverse effects. Bone loss and fractures are frequent after transplantation and involve multifactorial mechanisms.
  
  
  METHODS
  A retrospective analysis of 130 patients submitted to simultaneous pancreas-kidney transplantation (SPKT) and an identification of risk factors involved in de novo Charcot neuroarthropathy by multivariate analysis were used; P<0.05 was considered significant.
  
  
  RESULTS
  Charcot neuroarthropathy was diagnosed in 4.6% of SPKT recipients during the first year. Cumulative glucocorticoid doses (daily dose plus methylprednisolone pulse) during the first 6 months both adjusted to body weight (>78 mg/kg) and not adjusted to body weight were associated with Charcot neuroarthropathy (P=0.001 and P<0.0001, respectively). Age, gender, race, time on dialysis, time of diabetes history, and posttransplantation hyperparathyroidism were not related to Charcot neuroarthropathy after SPKT.
  
  
  CONCLUSIONS
  Glucocorticoids are the main risk factors for de novo Charcot neuroarthropathy after SPKT. Protocols including glucocorticoid avoidance or minimization should be considered.
authors.affiliation: Division of Nephrology, Federal University of São Paulo, Brazil. erikabr@uol.com.br
authors.forename: Érika B
authors.initials: ÉB
authors.lastname: Rangel
authors.forename: João R
authors.initials: JR
authors.lastname: Sá
authors.forename: Samirah A
authors.initials: SA
authors.lastname: Gomes
authors.forename: Aluizio B
authors.initials: AB
authors.lastname: Carvalho
authors.forename: Cláudio S
authors.initials: CS
authors.lastname: Melaragno
authors.forename: Adriano M
authors.initials: AM
authors.lastname: Gonzalez
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Linhares
authors.forename: Jose O
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D005260:Female; D033023:Foot Joints / Q000000981:diagnostic imaging / Q000473:pathology; D005938:Glucocorticoids / Q000009:adverse effects*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents