Immunosuppressive and postoperative effects of orthotopic liver transplantation on bone metabolism

Maureen M.J. Guichelaar, Michael Malinchoc, Jean Sibonga, Bart Clarke, J. Eileen Hay

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Bone loss occurs early after orthotopic liver transplantation (OLT) in all liver transplant recipients and leads to postoperative fractures, especially in cholestatic patients with the lowest bone mass. Little is known about the underlying changes in bone metabolism after OLT or about the etiology of these changes. Histomorphometric analysis of bone biopsies, a method that allows assessment of bone volume, resorption, and formation, has shown improved bone metabolism at 4 months after OLT. It has further suggested that accelerated posttransplant bone loss occurs in the first 1-2 months after OLT, probably by an additional insult to bone formation. This study attempts to correlate the histomorphometric bone changes in paired bone biopsies (OLT and 4 months after OLT) of 33 patients undergoing OLT for chronic cholestatic liver disease with the many clinical and biochemical changes in these patients over the same period. Cumulative steroid dosage early after OLT is shown to be important, presumably by decreasing bone formation rates. The actual effect of calcineurin inhibitors on this early phase of bone loss is less clear, although posttransplant histomorphometric findings suggest that tacrolimus-treated patients have an earlier recovery of bone metabolism and trabecular structure compared with cyclosporine patients. Other factors important in the recovery of bone metabolism after the early phase of bone loss are recovery of liver and gonadal function and better calcium balance.

Original languageEnglish (US)
Pages (from-to)638-647
Number of pages10
JournalLiver Transplantation
Volume10
Issue number5
DOIs
StatePublished - May 1 2004

Fingerprint

Immunosuppressive Agents
Liver Transplantation
Bone and Bones
Osteogenesis
Biopsy
Liver
Tacrolimus
Bone Resorption
Cyclosporine
Liver Diseases
Steroids
Calcium

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

Cite this

Immunosuppressive and postoperative effects of orthotopic liver transplantation on bone metabolism. / Guichelaar, Maureen M.J.; Malinchoc, Michael; Sibonga, Jean; Clarke, Bart; Hay, J. Eileen.

In: Liver Transplantation, Vol. 10, No. 5, 01.05.2004, p. 638-647.

Research output: Contribution to journalArticle

Guichelaar, Maureen M.J. ; Malinchoc, Michael ; Sibonga, Jean ; Clarke, Bart ; Hay, J. Eileen. / Immunosuppressive and postoperative effects of orthotopic liver transplantation on bone metabolism. In: Liver Transplantation. 2004 ; Vol. 10, No. 5. pp. 638-647.
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