Kidney Week

Abstract: PUB499

Prevalence and Trends of Quantitative Bone Anomalies in Kidney Transplant Patients: A Single-Center Experience

Session Information

• Publication Only

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Alfieri, Carlo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

Carlo Alfieri, MD

• Di Naro, Margherita, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Margherita Di Naro, MD

• Regalia, Anna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Anna Regalia, MD

• Verdesca, Simona, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Simona Verdesca

• Campise, Mariarosaria, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Mariarosaria Campise, MD

• Molinari, Paolo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Paolo Molinari, MD

• De liso, Chiara, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Chiara De liso, DrMed

• Castellano, Giuseppe, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

Giuseppe Castellano, MD, PhD

Background

Quantitative bone disorders are relevant in kidney transplanted patients (KTxps) especially during the first year of transplantation (KTx). We aim to report the preliminary data about our single center experience concerning the prevalence and the trend of quantitative bone anomalies in a cohort of KTxps.

Methods

We studied 469 kidney transplant patients (M=271, age 49±11 yrs) from 2004-2023. Post-KTx data at baseline (T0) and 12 months post-transplant (T12) were analyzed. Each patient had a DEXA at T0 and T12. BMD was given as g/cm2. BMD reduction of >5% in the first year of KTx was significant. T and Z-scores were calculated. Patients with T-score -1>T>-2.5 were osteopenic (OPN), and those with T-score<-2.5 were osteoporotic (OPS).

Results

Most patients had glomerulonephritis or autosomal dominant polycystic kidney disease (21% each). 82% received deceased donor transplants, and 68% underwent hemodialysis pre-transplant. 21% received anti-human thymocyte immunoglobulin induction, and most were maintained on tacrolimus (91%) and mycophenolate (85%). 90% received steroids (mean cumulative dosage at T12: 2887±926 mg). 33% had Vitamin D supplementation, with mean levels of 17±4 ng/dL in the first year post-transplant. Femoral and vertebral BMD remained stable. F-OPN and V-OPN were present at T0 and T12 in 57% and 38% of patients, whereas F-OPS and V-OPS in 17% and 26% of patients. 14% showed significant femoral BMD worsening, associated with older age, higher BMI, and urinary protein excretion. 16% showed significant vertebral BMD worsening, also associated with higher urinary protein excretion. Multivariate analysis identified baseline BMD, age at transplant, and Prot U at T0 as significant factors for BMD worsening.

Conclusion

Our data shows prevalent bone anomalies in kidney transplant patients from the beginning. Despite vitamin D supplementation , levels remained low in the first year post-transplant, indicating a need for intervention to improve bone health. While BMD was generally stable, many patients showed osteopenia or osteoporosis, with some worsening. Older age at transplant and higher urinary protein excretion were linked to BMD worsening. Ongoing BMD monitoring can help track bone health and personalize interventions.