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post transplant problem
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post transplant problem

What would create soft bone structure. I was transplanted last Nov. 2010(Major Liver Transplant w/full Liver), I died three(3) times during the procedure. After relearning to do everything, swallow, talk, sit, stand, walk, and most every other normal thing a person does, I started to have major back pain. Had a MRI and the Doctors found a compression fracture in my spine. They fixed it and then a few weeks later I had to have another MRI and they found a second compression fracture. They fixed that one and now I am experiance the same pain as the first two times. My Doctors changed my med. Predisone to Cellcept, and said that may be the cause. How long is this going to happen and is there any stop to the pain?
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Avatar_m_tn
Approach to the patient with transplantation-related bone loss.
Ebeling PR.
Department of Medicine (Royal Melbourne Hospital/Western Hospital) and Endocrinology,

Transplantation is an established therapy for end-stage diseases of the kidney, endocrine pancreas, heart, liver, lung, intestines and for many hematological disorders. Current immunosuppressive regimens with glucocorticoids and calcineurin inhibitors produce excellent patient and graft survival rates. This has resulted in both increases in transplant numbers and an increased recognition of previously neglected long-term complications of transplantation such as fractures and osteoporosis. Both pretransplantation bone disease and immunosuppressive therapy result in rapid bone loss and increased fracture rates. Patients are particularly at risk early after transplantation. The bone health of candidates for organ transplantation should be assessed with bone densitometry of the hip and spine. Spinal x-rays should be performed to diagnose prevalent fractures. Any secondary causes of osteoporosis should be identified and treated. Vitamin D deficiency should be corrected with vitamin D doses selected to achieve a serum 25-hydroxyvitamin D concentration of at least 20 ng/ml. All patients should receive calcium. Patients with kidney failure should be evaluated and treated for chronic kidney disease-mineral and bone disorder, including renal osteodystrophy. Secondary hyperparathyroidism, in particular, should be treated. Treatment is indicated in the immediate posttransplantation period irrespective of bone mineral density because further rapid bone loss will occur in the first several months after transplantation. Long-term organ transplant recipients should also have bone mass measurement and treatment of osteoporosis. Oral and iv bisphosphonates are the most promising approach for the management of transplantation osteoporosis. Active vitamin D metabolites may have additional benefits in reducing hyperparathyroidism, particularly after kidney transplantation.

http://www.ncbi.nlm.nih.gov/pubmed/19420272

Vitamin D in organ transplantation.

Stein EM, Shane E.

Department of Medicine, Columbia University Medical Center, 630 West 168th Street, PH8-864, New York, NY, 10032, USA, ***@****.
Abstract

Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)(2)D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.

http://www.ncbi.nlm.nih.gov/pubmed/21207011
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9 Comments Post a Comment
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Avatar_m_tn
I will try to get back later with some more information.
Off the top of my head I believe that loss of bone mass post liver transplant is not uncommon. I think it is more prevalent in women but it can also affect men. I also think that prednisone may accelerate the process so it might be a good move to take you off that drug.
What was your underlying disease that necessitated your transplant?
Are you taking any nutritional supplements?

I will try and get back tomorrow.

Mike
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Avatar_m_tn
Thanks for the info. I was a goldsmith/jeweler and I dealt with very nasty chemicals. My doctor said that I suffered from hemotoxic chemicals. I have a goldsmith for over 25 years and did most everything from repairs, to refining old gold, to designing and finishing custom pieces. It very hard to protect yourself in that kind of business. I do take some supplements. Calcium+D, Fish oil,and pottasium.I will be seeing my Transplant Doctor at the end of next week but I wanted to get some info before I go. I want to know as much as I can and other info I have  gotten is not so clear about what I am going through.I do take blood thinners but that doesn't seem to be any part of it. Thanks so far for the info and I I'll keep checking back in. Ken
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Avatar_m_tn
Approach to the patient with transplantation-related bone loss.
Ebeling PR.
Department of Medicine (Royal Melbourne Hospital/Western Hospital) and Endocrinology,

Transplantation is an established therapy for end-stage diseases of the kidney, endocrine pancreas, heart, liver, lung, intestines and for many hematological disorders. Current immunosuppressive regimens with glucocorticoids and calcineurin inhibitors produce excellent patient and graft survival rates. This has resulted in both increases in transplant numbers and an increased recognition of previously neglected long-term complications of transplantation such as fractures and osteoporosis. Both pretransplantation bone disease and immunosuppressive therapy result in rapid bone loss and increased fracture rates. Patients are particularly at risk early after transplantation. The bone health of candidates for organ transplantation should be assessed with bone densitometry of the hip and spine. Spinal x-rays should be performed to diagnose prevalent fractures. Any secondary causes of osteoporosis should be identified and treated. Vitamin D deficiency should be corrected with vitamin D doses selected to achieve a serum 25-hydroxyvitamin D concentration of at least 20 ng/ml. All patients should receive calcium. Patients with kidney failure should be evaluated and treated for chronic kidney disease-mineral and bone disorder, including renal osteodystrophy. Secondary hyperparathyroidism, in particular, should be treated. Treatment is indicated in the immediate posttransplantation period irrespective of bone mineral density because further rapid bone loss will occur in the first several months after transplantation. Long-term organ transplant recipients should also have bone mass measurement and treatment of osteoporosis. Oral and iv bisphosphonates are the most promising approach for the management of transplantation osteoporosis. Active vitamin D metabolites may have additional benefits in reducing hyperparathyroidism, particularly after kidney transplantation.

http://www.ncbi.nlm.nih.gov/pubmed/19420272

Vitamin D in organ transplantation.

Stein EM, Shane E.

Department of Medicine, Columbia University Medical Center, 630 West 168th Street, PH8-864, New York, NY, 10032, USA, ***@****.
Abstract

Vitamin D deficiency is prevalent among patients with end-stage organ failure awaiting transplant. Low serum 25-hydroxyvitamin D (25-OHD) levels in these patients may be related to many disease-specific factors, as well as decreased sunlight exposure and limited intake of foods containing vitamin D. Low serum 25-OHD levels are also extremely common following solid organ transplantation, both during the immediate postoperative period and in long-term graft recipients. Demographic and lifestyle factors are important in determining D status in transplant recipients. Worse vitamin D status is associated with poorer general health, lower albumin, and even decreased survival among these patients. Although several studies have demonstrated that active forms of vitamin D and its analogues prevent bone loss following transplantation, the data do not show consistent benefit. These therapies may have particular utility after renal transplantation. However, given the narrow therapeutic window with respect to hypercalcemia and hypercalciuria, and the demonstrated efficacy of bisphosphonates to prevent post-transplantation bone loss, we regard these agents as adjunctive rather than primary therapy for transplantation osteoporosis. The effects of 1,25(OH)(2)D on the immune system, which are still being elucidated, may have potential for reducing infections and preventing allograft rejection after transplantation.

http://www.ncbi.nlm.nih.gov/pubmed/21207011
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Avatar_m_tn
It appears as though there is much more research needed in order to understand bone loss post transplant and arrive at some firm therapeutic approach. Basically, what I gather from the articles I have read is that supplementation with calcium, Vitamin D and bisphosphonates may be beneficial. I have been taking magnesium oxide since my transplant 10 years ago but I am not clear about whether it affects bone loss.
I have read (I cannot recall the site) that Cellcept seems to be better than prednisone in this setting - bone loss - so hopefully your situation will improve.

I wish you the very best Ken.

Mike
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Avatar_m_tn
Post your question(s) here and find out what a real transplant physician thinks about it.

http://www.medhelp.org/forums/Liver-Transplant/show/274

I don't why this didn't occur to me immediately.

I apologize for that.

Mike
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Avatar_m_tn
Thanks for site. I had went back to my Transplant Hospital, Yep, with another possible fracture. This I will be seeing a back specialist at the Florida Orthropedic Insttute. I spent Thrtee days in the hospital and my Doctors at the hospital din not want to patch me up and send me home so they set up a specialist to see me. Now there is a chance that I might need surgery, but that will be decided when we have all the options on the table. The info has been great and I was able to pass it on to another patient.I have seen and talked to a few other Post-transplant patients and learned I could have been in worse shape so I am Thankful for that. This Dr. should be able to fill in the blanks for me . I guess he has dealt with other patients with the same problem.We will see. A few days of rest at home then it will be time to go to this guy. At the mean time My pain management Dr. Will make sure that I am as comfortable as possible. Well I have to contact myprimary care dr. And get a copy of my Dexa Scan results and get my med. files for all the x-rays, mri's,and ultrasounds. Well I check back in soon and see what is going on. Thanks, Ken
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Avatar_m_tn
I look forward to seeing a good report when you check back,

Good luck,
Mike
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Avatar_m_tn
Well I am back. I had a three day stay at the hospital and had to see a specialist. A third compression fracture was found (T12) they say it is not repairable. So now I am back in therapy to strengthen the rest of my body. The big change is that my therapy is in the water. I have 4 weeks of that then back(LOL) to the back Dr. At least I am still in pain management. It is a shame about the pill mills and such. It puts a black eye on those who actually need that type of relief. I am for control as long as they treat it fairly.My doctors are fairly happy with my progress with the transplant have relaxed some of my routines. Now if I just can get a routine working with my spine and all, the maybe I can be on a lower amount of meds. Thats what I'm working towards. Hope you are well and all. My regards, Ken
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Avatar_m_tn
I'm sorry to hear about the fracture but very encouraged by your attitude.
It's sometimes hard to stay positive but I really do believe that is crucial to getting well.
I wish you the very best.

Be well,
Mike
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