RHEUMATOLOGICAL COMPLICATIONS IN HEART-TRANSPLANT RECIPIENTS - A CROSS-SECTIONAL STUDY OF 365 PATIENTS

Rheumatological complications are sometimes disabling in heart transplant recipients and may negate the good results obtained with transplantation. The objective of this study was to evaluate the incidence of these complications. 365 consecutive heart transplant recipients (292 males and 73 females) were systematically interviewed and examined according to a standardized protocol. The mean age of the patients was 45.9 +/- 12.0 years (range : 11-68). The mean duration from transplantation to time of the study was 35.8 +/- 25.6 months (range : 1-115). The rheumatological disorders most frequently encountered were : gout, osteoporosis, osteonecrosis and myalgias. Early-onset polyarticular gout was diagnosed in 63/365 patients (17.3 %). This diagnosis was significantly associated with patient's age, time since transplant, male sex, serum uric acid, serum creatinine, diuretics intake and inversely associated with the serum cyclosporin levels. Hyperuricemia was observed in 75.9 % of transplant recipients with a mean of 507.5 +/- 132.5 mumol/l (range : 97-965). An osteoporotic fracture was present in 18/365 patients (4.9 %) and was significantly associated with the patient's age, but not with the dose of corticosteroids. Osteonecrosis was detected in 10/365 patients (2.7 %), always affected the hip, and was significantly associated with the patient's age, but not with the high doses of steroids. Myalgias were reported by 14/365 patients (3.8 %). Laboratory, electromyographic and histological analysis were negative. Rheumatological complications are frequent in heart transplant recipients and justify preventive and therapeutic management.