Patients who require long-term use for immunosuppression after organ transp
lantation are at risk for the development of osteonecrosis. The purpose of
this study was to determine the prevalence of symptomatic osteonecrosis of
the hip in patients who were managed with corticosteroids for immunosuppres
sion after orthotopic liver transplantation. We reviewed the relationship o
f the administration and dosage of steroids in 203 patients who underwent o
rthotopic liver transplantation. Overall, 29 of the 203 patients (14%) comp
lained of hip pain, but only 3 patients (2%) developed symptomatic osteonec
rosis of the hip. The osteonecrosis was diagnosed an average of 31 months a
fter transplantation (range, 26-38 months). There was no association noted
between steroid dose and the development of osteonecrosis. Routine screenin
g for osteonecrosis of asymptomatic liver transplant patients is not necess
ary.