Spine After Solid Organ Transplantation in Childhood: A Clinical, Radiographic, and Magnetic Resonance Imaging Analysis of 40 Patients

In Brief Study Design. A cross-sectional study of the spine in 40 young adults after solid organ transplantation in childhood. Objective. To evaluate the impact of organ transplantation and long-term immunosuppressive treatment on growing spine using magnetic resonance imaging (MRI). Summary of Background Data. A review of the current literature reveals no systematic evaluation of the spine after transplantation in childhood. Methods. A total of 40 adult patients (mean age 22.1 years, range, 16.0–27.0), who received either kidney, liver, or heart transplant as children, were evaluated. Mean follow-up after transplantation was 11.2 years (range 3.0–18.0). All patients filled in a questionnaire, underwent an interview and physical examination, as well as had MRI of the spine. Standing spinal radiographs were taken from patients with a rib hump ≥6°. Results. There were 8 (20%) patients who had a history of vertebral fracture. Eleven (28%) patients reported frequent back pain at rest. There were 15 (38%) patients who had scoliosis >10° (range 10°–69°). On MRI, narrowed disc spaces were noted in 32 (80%) patients, and irregular endplates were noted in 24 (60%). There were 14 (35%) patients who had at least 1 compressed or wedged vertebra (>20%). Patients treated for acute rejection had wedged vertebrae, speckled or black disc spaces, and irregular endplates more often than patients without rejections. Males had wedged vertebrae more often than females (P = 0.0067). Conclusions. Back pain, scoliosis, wedged vertebrae, and narrowed, degenerated disc spaces are common after solid organ transplantation in childhood. We evaluated 40 young adults who underwent kidney, liver, or heart transplantation in childhood. Of the patients, one fifth reported frequent back pain at rest, one third had scoliosis in radiographs, and one third had wedged vertebrae with irregular endplates on magnetic resonance imaging. Narrowed or degenerated disc spaces affected more than 80% of the patients. Males had wedged vertebrae more often than females.