Fracture incidence after liver transplantation: Results of a 10-year audit

Abstract

Background: High rates of fracture following liver transplantation were reported in earlier years, but the impact of subsequent changes in immune suppression and the introduction of bone-protective therapy on fracture rate have not been reported. Aim: The aim of this study was to document clinical fracture incidence during the period 1998-2008 in a single transplant centre, following the introduction of a bone management protocol. Design: It was designed as a retrospective cohort. Methods: Records were retrieved from 531 of 592 eligible patients in an audit of all patients undergoing a first liver transplant during the 10-year period. All fractures were verified radiologically. Results: The mean follow-up period was 61.4 months. Prior to transplantation 5.6% of patients had a history of fracture. Incident clinical fractures following transplantation were recorded in just 15 (3.5%) patients. The most common fracture site was the spine and the median time from transplant to fracture was 26 months (range 2-83 months). Conclusion: There was a low fracture rate in patients undergoing liver transplantation in this centre over the past 10 years. This rate is lower than that in previous reports, which is likely to reflect the use of lower doses of prednisolone for immune suppression and the administration of bone-protective therapy to high-risk patients. © The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.