Bone densitometry should be included in the evaluation of candidates for lung transplantation.

Bone loss and fractures are common complications of heart and liver transplantation, and are likely related to high-dose immunosuppressive therapy. We have previously demonstrated that many patients with end-stage lung disease already have osteoporosis and may be at even greater risk for fracture after lung transplantation. The purpose of this study is to determine the incidence of fracture in lung transplant recipients on osteoporosis prevention regimens, the relationship of fracture to pretransplant bone mineral density, and the impact of fracture on quality of life after lung transplantation. Twenty-one lung transplant candidates were prospectively evaluated with spine radiographs and bone mineral densitometry. Bone density was expressed as T scores, the number of standard deviations from the mean bone density of a young normal population of the same gender. Of 21 patients, 8 (38%) fractured during the first year. The mean pretransplant lumbar spine T score was significantly lower in the fracture patients (P = .03). Four of the 7 surviving fracture patients and 1 of the 10 patients who survived without fracture believed that chronic pain diminished their quality of life (X2 = 4.408; P = .04). These findings suggest that bone mineral density should be routinely included in the evaluation of lung transplant candidates. Patients with extremely low bone density or osteoporotic fracture should be counseled about the increased risk of fracture after transplantation.

Preliminary experience with mycophenolate mofetil used after lung transplantation.

This study reports our preliminary experience with mycophenolate mofetil (MMF)-based immune suppression after lung transplantation. Thirteen patients (group 1) received MMF as primary therapy immediately after transplantation. Use of MMF was associated with a linearized rate of 0.85 episodes of acute rejection per 100 patient days during the first 3 months after transplantation, as compared with rates of 1.49 and 1.38, observed in two groups of historical control subjects (p = .094 and p = .053, respectively). Rejection rates after the first 3 months were not lower than in historical control subjects. Nine additional patients were switched from azathioprine to MMF because of recurrent episodes of high-grade acute rejection (group 2). In this group, the linearized rate of acute rejection episodes declined significantly (p = .004) after initiation of MMF therapy. These data suggest a potential role for MMF in reducing the rate of acute rejection episodes after lung transplantation.