Vertebral fracture incidence and risk factors following liver transplantation: tertiary transplant center experience.

Abstract

Post-transplantation bone disease has been established as a common consequence of solid organ transplant. This study aims to assess the incidence and risk factors of vertebral compression fractures following liver transplant surgery in a tertiary transplant care center. Retrospective electronic audit included all patients undergoing liver transplant surgery at a tertiary transplant center, from 2016 to 2020, with at least 3 years of follow-up. Pre- and Post-transplant Data were collected. The Kaplan-Meier statistic was used to estimate the cumulative incidence of fractures. Statistical significance was determined by two-tailed P-values < 0.05. 434 patients were included in the audit, with a mean follow-up of 46.5 months. Vertebral fracture incidence was 8.3%, with most being at the thoracolumbar junction. The first year post-transplant recorded the highest fracture incidence rate with a mean of 10.5 months. The majority of patients were either osteoporotic or osteopenic pre and post-transplant. The utilization of bone protective medications was low pre- and posttransplant, at 11% and 18%, respectively. The mean duration of glucocorticoid use was 26 months. Post-transplant use and duration of prednisoloneand other immunosuppressant medications showed no significant association with fracture incidence. Pre-transplant osteoporosis was predictive for vertebral fracture posttransplant (p = 0.011). Our audit reveals a higher incidence of vertebral compression fractures following liver transplant compared to recently published data. The risk seems to be highest soon after the transplant. Post-transplantation bone disease prevention should focus on optimizing bone mass prior to transplantation and preventing bone loss in the early postoperative period.