Total Hip Replacement Due to Steroid-Induced Avascular Necrosis after Liver Transplantation: Report of a Case

초록

Steroid is known to be effective immunosuppressant but complicates many side effects including posttransplant diabetes, hyperlipidemia, osteopenia, osteonecrosis. Early steroid-weaning is being tried to solve these problems. A 41-year old man received living donor liver transplantation from his younger sister due to HBV-related liver cirrhosis. Immunosuppression was based on triple therapy, tacrolimus, mycophenolate mofetil, steroid. Methylprednisolone 500mg/day was administered intraoperatively and on postoperative day (POD) 1 then tapered. From POD 8 to 14, 20mg steroid was given every 12 hours and then 10mg steroid was given every 12 hours until POD 30. Steroid 5mg/day was given 2 months later. Posttransplant diabetes, hypertension and headache were developed. Liver biopsy was performed three times due to elevated liver enzymes at 5, 10, 14 months after operation. Final report was mild acute cellular rejection except last biopsy that showed no evidence of rejection. He was treated with intense immunosuppression without steroid pulse therapy. After second biopsy, steroid was given to 10mg/day for 3 months. He complained right hip joint pain and buttock radiating pain. Magnetic resonance imaging study revealed avascular necrosis of both femur heads. Right side was more severe than left. Right total hip replacement and left core decompression were performed at 14 months after LT. We had painful experience with long-term steroid therapy. After this event, we are trying to withdraw steroid early with close observation on acute cellular rejection.