Histologic Abnormalities of Bone before and after Kidney Transplantation

This chapter discusses the complexity of factors involved in post-transplant bone disease; it is useful to describe bone status at the time of transplantation and the changes that occur thereafter. All solid-organ transplantations share the deleterious impact of immunotherapy, in particular glucocorticoids, on calcium and bone metabolism. However, bone disease after kidney transplantation is unique. At the time of transplantation, kidney transplant recipients already suffer from various forms of renal osteodystrophy—that is, abnormalities in bone volume, bone turnover, and bone mineralization that might affect post-transplant bone disease. Also, even though renal function improves after kidney transplantation, patients may still show various degrees of renal insufficiency, which may worsen over time and may impact bone. Moreover, the number of diabetic patients on chronic dialysis undergoing kidney transplantation has increased. Types I and II diabetic patients have been shown to have low bone turnover and an increased risk for fractures, especially hip fractures.