Clinical study on avascular necrosis of the femoral head in 24 renal transplantation patients / 中华器官移植杂志

ABSTRACT

Objective To investigate the clinical features, diagnosis and therapy of avascular necrosis of the femoral head after renal transplantation Methods Of the 24 renal transplantation patients with avascular necrosis of the femoral head 0.7 - 7.8 years postoperatively, 20 cases were unilateral and 4 bilateral respectively. According to the standard of Ficat's, all cases were classed as 0-Ⅳ stages. All cases accepted immunosuppressive therapy that included corticoids. The corticoids were reduced in dose at the time when the patients were diagnosed as having avascular necrosis of femoral head and withdrawn in 2 weeks. Surgical treatment was not done unless the expectant treatment was invalid.Results The clinical manifestations of femoral head avascular necrosis after renal transplantation included knee joint, hip joint, inguina or thigh pain in the earlier period (Ⅰ-Ⅱa stage) and hip joint pain in progression (Ⅱb-Ⅳ stage). Some cases were associated with hip joint flex, adduct, abduction and intorsion dysfunction. After expectant treatment, the symptoms of hip were alleviated or disappeared in 4 cases; In 16 cases, the symptoms of hip were relieved to some extent, but Ficat’s stage had no change. Eight cases had no reaction to expectant treatment and were subjected to surgical operation. In 4 cases, acute rejection occurred after corticoid withdrawal, reversed after therapy by MP and ATG and could tolerance corticoid withdrawal again.Conclusion Corticoid is the main reason of avascular necrosis of the femoral head after renal transplantation. The therapeutic effectiveness of avascular necrosis of the femoral head was not satisfactory and the emphasis was put on the prevention.