Reduced fracture risk with early corticosteroid withdrawal after kidney transplant

Lucas Nikkel, S. Mohan, A. Zhang, D. J. McMahon, S. Boutroy, G. Dube, B. Tanriover, D. Cohen, L. Ratner, Christopher S. Hollenbeak, M. B. Leonard, E. Shane, T. L. Nickolas

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Corticosteroid use after kidney transplantation results in severe bone loss and high fracture risk. Although corticosteroid withdrawal in the early posttransplant period has been associated with bone mass preservation, there are no published data regarding corticosteroid withdrawal and risk of fracture. We hypothesized lower fracture incidence in patients discharged from the hospital without than with corticosteroids after transplantation. From the United States Renal Data System (USRDS), 77 430 patients were identified who received their first kidney transplant from 2000 to 2006. Fracture incidence leading to hospitalization was determined from 2000 to 2007; discharge immunosuppression was determined from United Networks for Organ Sharing forms. Time-to-event analyses were used to evaluate fracture risk. Median (interquartile range) follow-up was 1448 (808-2061) days. There were 2395 fractures during follow-up; fracture incidence rates were 0.008 and 0.0058 per patient-year for recipients discharged with and without corticosteroid, respectively. Corticosteroid withdrawal was associated with a 31% fracture risk reduction (HR 0.69; 95% CI 0.59-0.81). Fractures associated with hospitalization are significantly lower with regimens that withdraw corticosteroid. As this study likely underestimates overall fracture incidence, prospective studies are needed to determine differences in overall fracture risk in patients managed with and without corticosteroids after kidney transplantation. In this analysis of the United States Renal Data System, discharge from the hospital after kidney transplantation without maintenance corticosteroids is associated with a 31% reduction in fractures leading to hospitalizations.

Original languageEnglish (US)
Pages (from-to)649-659
Number of pages11
JournalAmerican Journal of Transplantation
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2012

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Adrenal Cortex Hormones
Transplants
Kidney
Kidney Transplantation
Fracture Fixation
Hospitalization
Information Systems
Incidence
Bone and Bones
Risk Reduction Behavior
Immunosuppression
Cohort Studies
Transplantation
Maintenance
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Nikkel, Lucas ; Mohan, S. ; Zhang, A. ; McMahon, D. J. ; Boutroy, S. ; Dube, G. ; Tanriover, B. ; Cohen, D. ; Ratner, L. ; Hollenbeak, Christopher S. ; Leonard, M. B. ; Shane, E. ; Nickolas, T. L. / Reduced fracture risk with early corticosteroid withdrawal after kidney transplant. In: American Journal of Transplantation. 2012 ; Vol. 12, No. 3. pp. 649-659.
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Nikkel, L, Mohan, S, Zhang, A, McMahon, DJ, Boutroy, S, Dube, G, Tanriover, B, Cohen, D, Ratner, L, Hollenbeak, CS, Leonard, MB, Shane, E & Nickolas, TL 2012, 'Reduced fracture risk with early corticosteroid withdrawal after kidney transplant', American Journal of Transplantation, vol. 12, no. 3, pp. 649-659. https://doi.org/10.1111/j.1600-6143.2011.03872.x

Reduced fracture risk with early corticosteroid withdrawal after kidney transplant. / Nikkel, Lucas; Mohan, S.; Zhang, A.; McMahon, D. J.; Boutroy, S.; Dube, G.; Tanriover, B.; Cohen, D.; Ratner, L.; Hollenbeak, Christopher S.; Leonard, M. B.; Shane, E.; Nickolas, T. L.

In: American Journal of Transplantation, Vol. 12, No. 3, 01.03.2012, p. 649-659.

Research output: Contribution to journalArticle

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AU - Nikkel, Lucas

AU - Mohan, S.

AU - Zhang, A.

AU - McMahon, D. J.

AU - Boutroy, S.

AU - Dube, G.

AU - Tanriover, B.

AU - Cohen, D.

AU - Ratner, L.

AU - Hollenbeak, Christopher S.

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AU - Nickolas, T. L.

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N2 - Corticosteroid use after kidney transplantation results in severe bone loss and high fracture risk. Although corticosteroid withdrawal in the early posttransplant period has been associated with bone mass preservation, there are no published data regarding corticosteroid withdrawal and risk of fracture. We hypothesized lower fracture incidence in patients discharged from the hospital without than with corticosteroids after transplantation. From the United States Renal Data System (USRDS), 77 430 patients were identified who received their first kidney transplant from 2000 to 2006. Fracture incidence leading to hospitalization was determined from 2000 to 2007; discharge immunosuppression was determined from United Networks for Organ Sharing forms. Time-to-event analyses were used to evaluate fracture risk. Median (interquartile range) follow-up was 1448 (808-2061) days. There were 2395 fractures during follow-up; fracture incidence rates were 0.008 and 0.0058 per patient-year for recipients discharged with and without corticosteroid, respectively. Corticosteroid withdrawal was associated with a 31% fracture risk reduction (HR 0.69; 95% CI 0.59-0.81). Fractures associated with hospitalization are significantly lower with regimens that withdraw corticosteroid. As this study likely underestimates overall fracture incidence, prospective studies are needed to determine differences in overall fracture risk in patients managed with and without corticosteroids after kidney transplantation. In this analysis of the United States Renal Data System, discharge from the hospital after kidney transplantation without maintenance corticosteroids is associated with a 31% reduction in fractures leading to hospitalizations.

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