Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study

Background There is a lack of evidence about the risk factors associated with osteonecrosis of the femoral head (ONFH). Purposes To determine the incidence and risk factors for ONFH following renal transplantation (RT). Methods In total, data of 681 RT patients (mean age at surgery, 49.5 ± 13.6 years; 249 women and 432 men) were evaluated to determine the incidence of ONFH. Hip magnetic resonance imaging (MRI) was performed six months after RT. The following potential predictors of ONFH were evaluated: (1) patient’s condition at RT; laboratory test results including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone before RT; blood relationship between the patient and donor; and mismatching number of human leukocyte antigens (HLAs), especially HLA class I and class II and (2) dosages of steroids after RT, immunosuppressive regimen, and incidence of acute rejection. Results ONFH was observed in 30 hips (21 cases, 3.1%). We successfully matched 63 patients without ONFH. Multivariate logistic regression analysis, adjusted for cumulative dosages of steroids, revealed that mismatching number of HLA (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.10–2.36; p = 0.014), HLA class II (HR, 3.73; 95% CI, 1.46–9.56; p = 0.001), P before RT (HR, 1.62; 95% CI, 1.02–2.58; p = 0.041), and Ca × P before RT (HR, 1.06; 95% CI, 1.01–1.11; p = 0.024) were risk factors for ONFH. Conclusion A greater number of HLA mismatches, HLA class II, serum P, and serum Ca × P were risk factors for ONFH after RT. Therefore, these factors should be evaluated in order to predict ONFH after RT.