Introduction Amongst patients on longterm parenteral nutrition, rates of osteoporosis vary between 41–67%.^1,2In the United States, 77.4% of patients awaiting intestinal transplantation had low bone mineral density (BMD).³It is not known how prevalent low BMD is amongst patients undergoing intestinal transplantation in the United Kingdom.

Method We retrospectively reviewed the notes and bone densitometry scans (DEXA) for all patients who had undergone isolated intestinal, modified multivisceral, or full multivisceral transplantation from December 2007 to December 2014.

Results 49 patients were transplanted including 5 acutely (4 mesenteric ischaemia, 1 intestinal failure associated liver disease) with no time for pre-operative DEXA. It was not known whether pre-operative DEXA was performed in 6 patients. Of the remainder, 33/38 (87%) had DEXA performed a median of 329 days (range 12–986) prior to transplantation. Osteoporosis was seen in 13/33 (39%) with a median hip T-score -2.7 (range -1.3 to -4.8), median spine T-score -3.1 (range -1.6 to -5.4), and median age at transplant 46 years (range 18–64). Osteopenia was seen in 11/33 (33%) with 9/33 (27%) having normal BMD.

Of those who did not have pre-operative DEXA but who were scanned within 1 year (n = 10), 7 had reduced BMD. Specifically, patients undergoing acute transplant demonstrated reduced BMD (osteopenia) in 2/5 (age 27 and 33 at transplant).

Patients were managed with a combination of calcium/Vitamin D and/or bisphosphonates, with two patients referred to a metabolic bone clinic. There were no cases of fragility fractures. Of the surviving patients who have had sequential DEXA, including ≥2 scans post-transplant (n = 7), there is a trend towards increasing BMD over subsequent years.

Conclusion Prevalence of low BMD is 72% in patients undergoing intestinal or multivisceral transplantation at our centre and these patients are often under the age of 50 years sometimes with profound osteoporosis (e.g. T -5.4). Poor bone health is not restricted to those on long term parenteral nutrition with intestinal failure but is also seen in patients with acute indications requiring transplant such as mesenteric infarction. As patients survive longer the sequelae of osteoporosis become important – addressing reduced BMD pre-operatively is important as improving bone health may take some years. Use of corticosteroid immunosuppression increases risk of reduced BMD in this cohort.

Disclosure of interest None Declared.

References

1. Pironi L, et al. Clin Nutr. 2002;21:289–296.

2. Cohen-Solal M, et al. J Bone Miner Res. 2003;18(11):1989–1994.

3. Resnick J, et al. Am J Transplant. 2010;10:2331–2340.