The musculoskeletal system is especially vulnerable after transplantation. Extended hospital stays due to fractures or muscle weakness can lead to other problems such as limited mobility and pneumonia. We want to minimize as many of these problems as possible.
Osteoporosis is thinning of the bones. Osteoporosis can be a major problem post transplant and places patients at high risk for fractures and subsequent complications such as blood clots and pneumonia from lack of activity.
Patients often have osteoporosis prior to transplantation, especially those with chronic obstructive pulmonary disease (COPD), cystic fibrosis or a history of treatment with high doses of steroids. Compression fractures of the back are most commonly seen, but fractures of the arms, legs, or hips can occur.
Great care should be taken to prevent falls. All patients undergo bone density tests prior to transplant and receive aggressive treatment for both osteopenia (bone mass decrease) or osteoporosis (bone density loss). Calcium with Vitamn D supplements and bone mass restorative medications (such as Fosamax) are used routinely after transplant.
Muscle weakness is seen in the post-operative period and often results in prolonged hospitalization. Patients at highest risk include those who are seriously unfit, had limited mobility prior to transplant or received high doses of steroids.
Other medications such as cyclosporin and Prograf can affect the nervous system and perpetuate weakness. Muscle weakness often resolves slowly over time. The goal is to keep patients free of complications during this slow recovery period.