Bilateral femoral capital avascular necrosis in a renal transplant recipient on tacrolimus-based immunosuppression.

Avascular osteonecrosis (AVN) of the femoral head is one of the most common skeletal complications of kidney transplantation [1,2]. Factors governing its prevalence, risk factors and therapy remain controversial, even four decades after the initial description. It is generally accepted that corticosteroids play a crucial role in the pathogenesis. Prevalence of this complication decreased following the introduction of cyclosporin [1,3], but the effect of more recently introduced immunosuppressive agents is not so well documented. Here we report a 22-year-old patient who developed bilateral femoral head AVN 3.5 months after kidney transplantation, despite being on tacrolimus.