Bone mass and mineral metabolism in liver transplant patients treated withFK506 or cyclosporine A

The purpose of this study was to compare the effects of Cyclosporine A (CyA ) and FK506 on bone mass and mineral metabolism in liver transplantation (L T) patients. A prospective study was performed on 18 male patients who unde rwent LT treated with CyA, and 7 LT patients who received FK506, Bone miner al density (BMD) of the lumbar spine and proximal femur (DPX-L) was measure d before and at 6, 12, and 24 months after transplantation. Moreover, intac t parathyroid hormone (PTH) and 25-hydroxyvitamin D (25OHD) levels were det ermined at the same time. The cumulative dose of glucocorticoids was calcul ated in all patients. At 6 months, lumbar BMD decreased 5.2 +/- 1.2 % (P = 0.0005) and 2.9 +/- 2.1 % (p = ns) in CyA and FK506 groups, respectively. L umbar BMD reached baseline values at 1 year in the FK506 group and 2 years after LT in the CyA group. Moreover, significant intergroup differences in femoral neck BMD changes after 2 years of transplant were observed (CyA: -5 .2 +/- 1.97 versus FK506: +1.55 +/- 2.2 %; P = 0.039). In the first year po sttransplant both groups showed a marked increase in PTH and 25OHD levels. The mean cumulative dose of glucocorticoids was higher in the CyA group (Cy A group 11.06 +/- 0.46 g versus FK 506 group 6.71 +/- 0.42 g; P < 0.001), a nd multiple linear regression analysis showed a negative correlation betwee n BMD changes at the lumbar spine and mean cumulative dose of glucocorticoi ds (P = 0.022). In conclusion, our data suggest that after liver transplant ation treatment with FK506 shows a more favorable long-term effect on bone mass evolution than CyA therapy. These differences seem to be associated wi th the lower dose of glucocorticoids used in the FK506 group.