AB0828 RHEUMATIC PATHOLOGY AFTER SOLID ORGAN TRANSPLANTATION
Authors: Madalina Duna, Denisa Predeteanu, Violeta Bojinca, Ianos Pahomea, Nicolae Boleac, Radu Poenaru, Narcis Copca
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Organ transplantation has become as effective therapy for end-stage renal, hepatic, cardiac and pulmonary diseases within the past 2 decades. Osteoporosis, low level of vitamin D and hyperuricemia have emerged as frequent and sometimes devastating complications of organ solid transplantation process. <h3>Objectives</h3> The objective of the study was to detect the prevalence of osteoporosis, low level of vitamin D and hyperuricemia in <i>liver</i> and lung <i>transplant patients</i>. <h3>Methods</h3> We evaluated a cohort of 48 patients who underwent liver and lung transplantation in a single Romanian center between July 2014 and January 2019. 44 pts undergone liver transplantation and 4 undergone lung transplantation. We have measured the level of the 25-hydroxyvitamin D and serum urate before and after the transplantation in all patients. <h3>Results</h3> The average age of the patients was 53.7 ± 10 years (range 32–69) with a sex ratio 1:1. 32 (66%) of patients came from urban area. 8 (16.6%) patients were excluded from this study due to recurrent HCV infection with hepatic failure in the first few months after transplantation. The final group consisted of 40 patients. The indications of the orthotopic liver transplantation in these patients were: cirrhosis secondary chronic hepatitis B, C, D virus infection in 24 (60%) cases, autoimmune hepatitis in 7 (17.5%) patients, alcoholic liver disease in 2 (5%) patients, hepatocellular carcinoma in 1 (2.5%) patient, polycystic liver disease in 1 (2.5%) patient and nonalcoholic fatty liver disease in 1 (2.5%) patient. In all 4 cases with lung transplantation, the reason for of the lung transplantation was chronic obstructive pulmonary disease (COPD). 36 (91%) patients were receiving combination immunosuppressant therapy (tacrolimus and) and only 4 (9%) patients were receiving cyclosporine; in this situation, the association between tacrolimus and mycophenolate mofetil was preferred versus cyclosporine because of the negative <i>effect of cyclosporine on the bone.</i> Post-transplant, hyperurcemia (according to local <i>laboratory</i> reference values &gt;6.5 mg/dL) was presented in 28 (70%) transplant recipients but none of the hyperuricemic patients developed gout. Despite this fact, all of them were treated with allopurinol. Vitamin D deficiency was reported in 22 (55%) transplant recipients. Also, <i>a DXA scan</i> of the lumbar spine and femoral neck <i>measuring T-score and bone mineral density</i><i> (</i>BMD) <i>was routinely performed after a mean interval of 4-6 months post-transplant</i>. From this group of patients, 10 (25%) patients had decreased bone mineral density (&lt;2.5 SD) and 8 (20%) of them who complained of back pain in the early posttransplantation period, presented on x-rays <i>vertebral fragility fractures</i> at different sites (most frequently in the thoracic spine). The mean T-score was -2.7 and the mean BMD was 27.4 kg/m<sup>2</sup>. <h3>Conclusion</h3> The standard care of liver and lung transplant recipients must includes, besides other lab tests, a measurement of 25-hydroxyvitamin D and serum urate. For patients with low levels of 25-hydroxyvitamin D, evaluation for osteoporosis (risk factors, x-ray, DXA scan) should be mandatory. <h3>References</h3> [1] P. R. Ebeling, "Approach to the patient with transplantation-related bone loss," The Journal of Clinical Endocrinology &amp; Metabolism, vol. 94, no. 5, pp.1483–1490, 2009. [2] Sullivan PM, William A, tichy EM, "Hyperuricemia and gout in solid-organ transplant: update in pharmacological management,"Prog Transplant. 2015Sep;25(3):263-70. doi: 10.7182/pit2015322. [3] Mazzali M, "Uric acid and transplantation", Semin Nephrol. 2005Jan;25(1):50-5. <h3>Disclosure of Interests</h3> Madalina Duna: None declared, Denisa Predeteanu: None declared, Violeta Bojinca Speakers bureau: multiple, Ianos Pahomea: None declared, Nicolae Boleac: None declared, Radu Poenaru: None declared, Narcis Copca: None declared