Fracture incidence and mortality in kidney transplant recipients compared with waitlisted dialysis patients: A single-center retrospective analysis.

AIMS: Kidney transplantation (KT) improves survival in end-stage renal disease (ESRD); however, the post-transplant fracture risk remains uncertain. This study aimed to compare the fracture incidence between kidney transplant recipients (KTRs) and waitlisted dialysis patients and to examine the association between fracture events and all-cause mortality in each group. MATERIALS AND METHODS: This study included a single-center cohort of 504 KTRs and 423 waitlisted dialysis patients treated at a tertiary hospital in South Korea from 1998 to 2019. Fractures were identified through radiological report review, and mortality data were retrieved from medical records. Multivariate Cox regression models were used to evaluate mortality predictors, including fracture events, as covariates. RESULTS: The fracture incidence did not differ significantly between KTRs (9.1%) and dialysis patients (12.5%). Moreover, fractures were not significantly associated with increased mortality in either group (KTRs: hazard ratio (HR), 2.03; 95% confidence interval (CI), 0.62 - 6.67; p = 0.24; dialysis: HR, 0.97; 95% CI, 0.12 - 8.08; p = 0.98). Age was the strongest mortality predictor. Among KTRs, tacrolimus use was associated with lower mortality compared with cyclosporine (HR, 0.18; 95% CI, 0.05 - 0.66; p = 0.009). CONCLUSION: KTRs have a fracture risk comparable to that of dialysis patients, and fractures were not significantly associated with mortality. The survival benefits of KT are driven by factors other than fracture-related complications. Ongoing, proactive bone health management remains essential in KTRs because transplantation does not eliminate the elevated fracture risk.