THE IMPACT OF PRE-OPERATIVE FACTORS FOR OSTEOPOROSIS IN LIVER TRANSPLANT RECIPIENTS

P Wong^1,3, J Latella¹, L Vautour^1,2, M Cantarovich^1,3, M Deschenes^1,3

Departments of Medicine¹, Endocrinology² and Liver Transplantation³, McGill University, Montreal, Quebec

BACKGROUND: Osteoporosis is a common complication after liver transplantation (OLT) and accurate prediction of individuals at risk of osteoporosis is needed for proper planning of long-term management.
OBJECTIVE: To examine the impact of pre-operative risk factors for osteoporosis in liver transplant recipients at the McGill University Health Centre (MUHC).
METHODS: All patients transplanted between 1996 - 2002 were eligible for this retrospective cohort study. Data from 142 patients were analyzed using multiple linear regression techniques. The main outcome variable was bone mineral density (BMD) in mg/cm² at the femoral neck 1-year post-OLT and study variables examined were age, gender, body mass index (BMI), total bilirubin, prothrombin time, Child-Pugh class (CPC), ethnic background and etiology of liver disease.
RESULTS: Female gender, increasing age, low BMI, and disease etiologies of viral hepatitis, alcohol or cholestatic liver disease were the most important variables in the final model. Below a BMI of 30, men were predicted to have higher BMD's than women, but this was reversed when the BMI was >30. A 1 unit increase in BMI was protective by a factor of 7.9´ favoring women over men. Cholestatic liver disease was the worst factor in females, with losses 4.8´ more than men (193 vs. 40.4 mg/cm²). Viral hepatitis and alcohol associated liver disease were similar to each other in severity of bone loss (50 vs. 59 mg/cm²). Total bilirubin level, prothrombin time, ethnic background, CPC and other etiologies for liver disease were not significant factors affecting BMD in this cohort of patients. The model had an overall R² of 0.29 and F-test value of 5.52 (p<0.0001).
CONCLUSIONS: Transplant recipients who should be targeted prior to surgery for aggressive interventions to minimize their long-term risk of osteoporosis at the femoral neck include women of advanced age with low BMI, and having either viral hepatitis, alcohol or especially, cholestatic liver disease. Further research is necessary to determine the most efficacious therapy to use pre- and post liver transplantation.