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DOI: 10.1055/s-0030-1268914
Impaired bone geometry after heart and heart-lung transplantation in childhood
Aims: Impaired bone health has been advocated after solid organ transplantation in adult and pediatric patients. Osteoporosis accompanied by fractures have been found also in heart transplantation recipients.
Methods: Parameters of bone mineral density (BMD) and bone geometry were measured in 34 pts. (15 f, mean age 14.6±5.5 y) 5.28±5.16 y after heart- (n=30) and heart-lung-transplantation (n=4) using peripheral computed tomography (pQCT). Transplantation had been performed because of dilated cardiomyopathy (DCM) in 25, congenital heart disease (CHD) in 5, idiopathic pulmonary hypertension (iPH) in 3 patients and arrhythmogenic right ventricular dysplasia (ARVD) in 1 patient at a mean age of 9.4±6.1 y.
Results: Trabecular BMD (z-scores –0.82±0.50, p<0.01) was reduced and cortical BMD (0.62±1.17, p<0.05) increased in pts. (n=11) on steroids, whereas pts. on immunosuppression with Tacrolimus showed normal trabecular BMD (–0.19±1.03). All patients had normal total CSA (–0.22±1.50) and relatively enlarged medullary CSA (0.44±1.37) resulting in smaller cortical CSA (–0.91±1.20, p<0.01). Mean muscle CSA was significantly reduced (–2.02±0.99, p<0.001) irrespective of glucocorticoid treatment and correlated significantly with cortical CSA (r=0.43, p=0.001).
Conclusion: After heart- and heart-lung-transplantation in childhood, all of our patients showed altered bone geometry and low muscle CSA. Patients on glucocorticoid treatment had additionally lower trabecular BMD. The clinical impact of these findings on increased risk for fractures has to be determined.