Background: Liver transplant (LT) candidates have metabolic bone disorders that may influence the development of skeletal fractures after LT. Our aims were to analyse bone-disorder characteristics in patients included in a screening pretransplant program for preventing bone disease after LT.
Methods: We analysed the clinical and laboratory data of LT candidates included in the screening programme, from 2010 to 2014. Lumbar and femoral BMD (DXA) and spinal X-rays were also evaluated.
Results: Three hundred and forty-five LT candidates (M/F:253/92, age:55.4+9.8 years) were included. Eleven patients had cholestatic liver diseases, 87 had alcoholic cirrhosis, 168 had cirrhosis of viral aetiology, and the remaining 79 had mixed liver diseases. 142 patients had a hepatocellular carcinoma (HCC). Eleven HIV-positive LT candidates were also evaluated. 29% of patients had densitometric osteoporosis and 48% osteopenia. Moreover, 24% of them had associated skeletal fractures. 25-OHD levels were <20 ng/ml in 83% of patients. When evaluating by gender, female patients showed higher prevalence of fractures (p<0.05), lower lumbar and femoral BMD (gr/cm2) (p<0.05) and higher 25-OHD values (p<0.05) than male patients. Nevertheless, no differences between sexes were found in the prevalence of osteoporosis or osteopenia. When evaluating by liver disease, patients with HCC showed less severe hepatic disease (p<0.001), lower prevalence of skeletal fractures (p<0.05) and higher BMD (p<0.05) and 25-OHD values (p<0.001) than non-HCC patients, whereas HIV-positive patients shower a higher prevalence of osteoporosis (p<0.001) and lower femoral BMD values (p<0.05) than non-HIV patients.
Conclusions: Liver transplant candidates show an elevated prevalence of fractures, low bone mass and vitamin D deficit. Low bone mass and fractures are more frequent in female patients; and vitamin D deficiency is more common in male patients. Bone metabolism disorders are less severe in LT candidates with hepatocellular carcinoma, while HIV-positive patients have high risk of osteoporosis.
Disclosure: The authors declared no competing interests.