Changes in calcium homoeostasis in patients undergoing liver transplantation: effects of a single infusion of pamidronate administered pre-operatively

被引:11
作者
Bishop, NJ
Ninkovic, M
Alexander, GJM
Holmes, SD
Milligan, T
Price, C
Compston, JE
机构
[1] Univ Cambridge, Addenbrookes Hosp, Dept Med, Cambridge CB2 2QQ, England
[2] SKB Pharmaceut, Harlow CM19 5AW, Essex, England
[3] St Bartholomews Hosp, London E1 2AD, England
基金
英国惠康基金;
关键词
bisphosphonates; liver transplantation; parathyroid hormone;
D O I
10.1042/CS19990086
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Bone turnover, bone loss and fracture risk increase after liver transplantation. it has been postulated that peri-operative administration of a bisphosphonate might prevent bone loss and reduce fracture rate. We studied the effects of a single pre-operative dose of pamidronate on biochemical parameters of skeletal metabolism in the first month after liver transplantation. In a randomized, single-blind study, six of 12 patients with chronic liver disease received 60 mg of pamidronate intravenously on a single occasion 1-30 days before transplantation. Six other patients undergoing transplantation received no pamidronate. We measured serum calcium, phosphate, albumin, bone-specific alkaline phosphatase, plasma parathyroid hormone and tartrate-resistant acid phosphatase before pamidronate infusion and at frequent intervals during the first 30 post-operative days. In treated patients, plasma parathyroid hormone increased 12-fold over baseline values and remained elevated in comparison with baseline at days 26-30; serum calcium and phosphate fell significantly, returning to normal at around day 14 postoperatively. There were no significant changes in any parameter in the untreated group. No changes in bone formation or resorption markers were observed in either group. The large increase in plasma parathyroid hormone concentrations in the treated group is probably secondary to the fall in serum calcium. The magnitude of the increase is much greater than that seen after pamidronate infusion in other patient groups. The lack of change in, or correlation of, serum calcium and plasma parathyroid hormone in the untreated group suggests that additional factors release calcium from bone after liver transplantation, presumably by increasing bone resorption.
引用
收藏
页码:157 / 163
页数:7
相关论文
共 26 条
[1]   Bone mineral status in end-stage liver disease and the effect of liver transplantation [J].
Abdelhadi, M ;
Eriksson, SAV ;
Eriksson, SL ;
Ericzon, BG ;
Nordenstrom, J .
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, 1995, 30 (12) :1210-1215
[2]  
AKATSU T, 1991, J BONE MINER RES, V6, P183
[3]  
ARNOLD JC, 1992, TRANSPLANT P, V24, P2709
[4]   Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures [J].
Black, DM ;
Cummings, SR ;
Karpf, DB ;
Cauley, JA ;
Thompson, DE ;
Nevitt, MC ;
Bauer, DC ;
Genant, HK ;
Haskell, WL ;
Marcus, R ;
Ott, SM ;
Torner, JC ;
Quandt, SA ;
Reiss, TF ;
Ensrud, KE .
LANCET, 1996, 348 (9041) :1535-1541
[5]   CHINESE-HAMSTER OVARIAN-CELLS TRANSFECTED WITH THE MURINE INTERLEUKIN-6 GENE CAUSE HYPERCALCEMIA AS WELL AS CACHEXIA, LEUKOCYTOSIS AND THROMBOCYTOSIS IN TUMOR-BEARING NUDE-MICE [J].
BLACK, K ;
GARRETT, IR ;
MUNDY, GR .
ENDOCRINOLOGY, 1991, 128 (05) :2657-2659
[6]  
BODY JJ, 1995, J BONE MINER RES, V10, P1191
[7]  
Boros P, 1997, CLIN TRANSPLANT, V11, P588
[8]  
CHAMBERLAIN P, 1995, CLIN CHEM, V41, P1495
[9]   HEPATIC OSTEODYSTROPHY - VITAMIN-D METABOLISM IN PATIENTS WITH LIVER-DISEASE [J].
COMPSTON, JE .
GUT, 1986, 27 (09) :1073-1090
[10]   Early increase in plasma parathyroid hormone levels following liver transplantation [J].
Compston, JE ;
Greer, S ;
Skingle, SJ ;
Stirling, DM ;
Price, C ;
Friend, PJ ;
Alexander, G .
JOURNAL OF HEPATOLOGY, 1996, 25 (05) :715-718