Endocrine Abstracts (2007) 13 P14

Fractures following orthotopic liver transplantation

Neil Gittoes1, Bridget Gunson1 & Douglas Thorburn2

1University of Birmingham, Birmingham, United Kingdom; 2University Hospital Birmingham, Birmingham, United Kingdom.

Each year ∼700 patients undergo orthotopic liver transplant (OLT) in the UK. With excellent outcomes reported (1 and 5 year survivals of 90% and 70% respectively) increasing attention is paid to ensuring long-term wellbeing after transplantation. A large proportion of patients are diagnosed with osteoporosis and risk of fracture in the post-transplant period may be as high as 30% following transplant. The exact aetiology of this increase in fracture risk is unclear, although high dose glucocorticoids (GC) are likely to contribute significantly. In more recent years, steroid sparing immunosuppressant regimens have been introduced. Thus it is unclear using contemporary management, what the risk is of osteoporotic fracture associated with OLT. We have performed a retrospective survey of 1500 patients who received OLT at this unit over 10 years to determine fracture incidence and management of osteoporosis risk. Data presented are from initial 622 responses (320 female). Median age at transplant was 51(3–73) years with median current age 59(19–85) years. Median time since first transplant was 96(5–264) months. 409 fractures occurred in 253(41%) patients; 298(51%) occurred prior to transplant. In patients taking GC for <=3/12 (183) 8.7% had post-transplant fracture; those taking GC >3/12 (235) experienced post-transplant fracture in 15.3%; P=0.04. (No GC data on 204 patients at time of writing.) 361(58%) had no DXA scan performed at any time and 131(41%) women and 210(70%) men received no active treatment for bone health. Risk of fracture was high in this patient population undergoing OLT. Risk was substantial prior to- and subsequent-to OLT. From preliminary data available at writing, prolonged GC-usage substantially increases the risk of fracture following OLT. DXA scans are performed in minority of patients and treatment is initiated in only 30% men and 59% women. Further analysis of complete data set should allow assessment of fracture risk following introduction of GC-sparing immunosuppressant regimens.

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