O28
Fracture Risk Post Renal Transplantation in England 2001-2013: A Population Study
Julia Arnold, Irena Begaj, David Bagnall, Daniel Ray, Adnan Sharif, Charles Ferro.
Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust
Background
Fractures are associated with high morbidity and economic costs in the general population.
However there is a paucity of information on fractures after renal transplantation and the
majority of studies conducted are out of date and based on population cohorts in the United
States (US). As longevity increases, there is a need to attenuate long-term complications after
renal transplantation. To date there is no data published on fracture rates post renal transplant in
the United Kingdom (UK) population.
Methods
Data was obtained from the Hospital Episode Statistics database on renal transplants performed
in England between April 2001 and March 2013 and post-transplant fracture-related
hospitalisation. Mortality data was obtained from the Office of National Statistics.
Results
In total, 21,769 first renal transplant procedures were analysed with 112,512 patient-years
follow up. Overall 836 (3.8%) kidney allograft recipients sustained a fracture requiring
hospitalisation; 173 of these sustained a hip fracture. Event rate was 9.99 for any fracture and
1.54 for hip fracture per 1000 patient-years. The most common fractures were femur (21.3%),
radius/ ulna (18.4%) and foot/ ankle (10.8%).
Accounting for the competing risk of mortality, our study showed that increasing age, female
gender, White ethnicity and a history of pre-transplant diabetes mellitus or previous fracture
were associated with increased all fracture and hip fracture risk post renal transplantation.
Death occurred in 2,407 (11.1%) kidney allograft recipients with 173 deaths occurring after any
fracture. Death occurred in 57 of the 173 allograft recipients who sustained a hip fracture. In an
extended Cox-model, hip fracture as a time-varying factor was independently associated with
an increased risk of death (Hazard Ratio 3.288, 95% Confidence Intervals 2.513-4.301;
P<0.001).
Conclusions
Fracture rates post renal transplantation in our study are lower than most previously reported
historical cohorts. Hip fractures are associated with subsequently increased mortality. Our
results can be used for sample size requirements for fracture prevention trials. Owing to the
current lack of evidence, further work is required to investigate the association between fracture
risk and renal transplantation and attempt to address this major cause of morbidity in the kidney
allograft recipient population.