BONE AND JOINT COMPLICATIONS OF HEART-TRA NSPLANTATION

Heart transplantation is an effective means of treating irreversible h eart failure in selected patients. Preventing organ rejection requires immunosuppressor treatment with corticosteroids, azathioprine and/or cyclosporine. Bone and joint complications are frequent and increase o verall morbidity directly related to antirejection therapy. Corticoste roids favour osteopenia which can be detected by measurement of bone d ensity. The risks include spontaneous wedge fractures of the spine and aseptic necrosis. The frequency of complications has been reduced wit h the use of cyclosporine allowing a reduction in corticosteroids. Rai sed serum urate levels and increased risk of gout can be induced by cy closporine. The gout in these patients has a particular course since i t appears rapidly after only a few months of hyperuricaemia. Several j oints may be involved with production of tophi. Treatment is particula rly difficult. Its frequency increases after heart transplantation com pared with other organs which can be explained by the more prevalent p rescription of diuretics which further aggravate urate secretion. Thes e complications cause further discomfort in transplant recipients.