Osteonecrosis after lung transplantation: Cystic fibrosis as a potential risk factor

Background. Osteonecrosis is a known complication after transplantation of solid organs. The incidence of osteonecrosis after lung transplantation is not well documented. Methods. We investigated the incidence of symptomatic osteonecrosis in lung transplant recipients, transplanted between November 1992 and June 1998 at our institution. For the detection of osteonecrosis, all patients complain ing of musculoskeletal pain underwent magnetic resonance imaging. Demograph ic characteristics, time after transplantation, etiology of underlying lung disease, and the number of steroid pulses for rejection episodes were comp ared for patients with and without osteonecrosis. Results. Of 63 transplant recipients, all 49 with a follow-up of >3 months were included for analysis. Of seven symptomatic transplant recipients, fiv e cases of osteonecrosis (10%) were detected at a median duration of 216 da ys (range 44-600) after transplantation. Patients with osteonecrosis have b een treated with the same immunosuppressive regimen and with an equal numbe r of steroid pulses for acute rejection episodes (1.4+/-1.1 vs, 1.4+/-1.5, P=0.69), but were younger (26+/-8 vs. 40+/-11 years, P<0.01) than other tra nsplant recipients. Symptomatic osteonecrosis was detected in four of 14 pa tients (29%) with cystic fibrosis (CF), compared with one osteonecrosis amo ng 35 patients (3%) with other underlying diseases (P<0.02). Within the gro up of CF patients, specific clinical and demographic characteristics correl ating with the risk for subsequent osteonecrosis could not be found. Conclusion. In lung transplant recipients, CF may be a risk factor for the development of symptomatic osteonecrosis.