Musculoskeletal manifestations in liver transplantation recipients

BACKGROUND:: The prevalence and type of musculoskeletal problems among liver transplant recipients have not been well characterized in the current literature. OBJECTIVE:: We conducted a retrospective analysis of both outpatients and inpatients (total 234) who underwent liver transplantation or had rheumatologic consultation during 2002-2004, to document the cause for their rheumatologic symptoms. We hypothesized that infection, crystal diseases, and corticosteroid complications would be more common in this cohort of immunosuppressed patients as compared with de novo connective tissue disease. RESULTS:: Among the outpatients, we found that arthralgia presumably secondary to tacrolimus/sirolimus; osteoarthritis, peripheral neuropathy, and myalgia were the most common diagnoses. The only autoimmune disease documented was Hepatitis C Virus-associated cryoglobulinemic vasculitis. Hyperuricemia was also prevalent in this patient population. Infection and gout were seen frequently among the inpatients. CONCLUSIONS:: It is important for physicians to be cognizant of the variety and prevalence of musculoskeletal disorders in the liver transplantation patient population.