Schachtner T, et al. – Considering reports of increased risk of avascular necrosis (AVN) due to bone disorder, steroid use, and common comorbidities among kidney transplant recipients, researchers studied risk factors and clinical characteristics of AVN in 765 KTRs from 2001-2013. Cases of symptomatic AVN were identified using hip X-ray, radioisotope bone scan, or magnetic resonance imaging. Findings revealed a decreasing incidence of AVN, possibly due to replacement of cyclosporine by tacrolimus, over the last decade. Additionally, the investigators found male sex to be independently related to AVN. Femoral head AVN was observed in 83% of cases, and these cases were managed surgically. Findings raised the hypothesis of an ischemic steal syndrome due to the allograft kidney impacting AVN at the allograft side.