Aseptic necrosis after renal transplantation in children
C. H. Uittenbogaart, A. S. Isaacson, P. Stanley, A. J. Pennisi, M. H. Malekzadeh, R. B. Ettenger and R. N. Fine
Aseptic necrosis developed in 11 (6%) of 171 recipients of renal allografts
who underwent transplant operations at Childrens Hospital of Los Angeles
between February 1967 and August 1977. Pain was the predominant presenting
symptom and preceded roentgenographic evidence of aseptic necrosis by as
long as seven months. Initial symptoms occurred two months to four years
posttransplant. Limited weight bearing and reduction in the dosage of
prednisone failed to prevent the progressive destruction of five femoral
heads in three patients. Hip replacement led to an amelioration of the
symptoms and a resumption of normal activity in each patient. Two patients
with involvement of multiple osseous structures have persistent knee and
elbow joint pain and effusions, and one of them has required prosthetic
replacement of the proximal humerus. No therapy was required for patients
with aseptic necrosis of single bones of the hand and foot. There was no
statistically significant difference in the total steroid dose received
during the first posttransplant year between patients in whom aseptic
necrosis developed, and those in whom it did not develop.
