The Journal of Bone and Joint Surgery, Vol 69, Issue 8 1226-1228, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
Cyclosporin A and osteonecrosis of the femoral head
J Landmann, N Renner, A Gachter, G Thiel and F Harder
Division of Organ Transplantation, University Hospital, Basel, Switzerland.
A vascular osteonecrosis has occurred in 5 to 40 per cent of patients who
have undergone transplantation of a kidney and generally has been
considered to be a complication of the use of corticosteroids. Currently
cyclosporin A is in general use for its immunosuppressive property, so that
a lower dose of corticosteroids is needed. We analyzed the cases of a
series of our patients who underwent transplantation of a kidney in order
to find out if our present regimen, using cyclosporin A, influenced the
prevalence of osteonecrosis of the femoral head. Of a total of 270
patients, osteonecrosis of the femoral head developed in fifteen of 174 who
received conventional immunosuppressive therapy and in only one of
ninety-six who received cyclosporin A (p less than 0.05). During the first
two months after transplantation, the mean dose of prednisone was
approximately 2.5 milligrams per kilogram of body weight per day in the
group that received conventional immunosuppressive therapy and
approximately 1.1 milligrams per kilogram of body weight per day in the
group that received cyclosporin A (p less than 0.001). We concluded that
the pathogenesis of the osteonecrosis in patients who underwent
transplantation of a kidney was probably related to the higher doses of
corticosteroids that were administered.
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