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Background With the increase of survival in liver transplantation recipients,more patients are at a high risk of developing osteonecrosis,especially in the femoral head,due to immunosuppressive treatment.The purpose of this study was to report the incidence,possible risk factors,and outcome of symptomatic osteonecrosis of the femoral head (ONFH) in adult patients with current immunosuppressive agents and individual protocol after liver transplantation in China.Methods A ratrospective analysis was performed on 226 adult patients who underwent orthotopic liver transplantation (OLT) at a single liver transplantation institution between January 2004 and December 2008.The posttransplant survival time (or pre-retransplantation survival time) of all the patients were more than 24 months.The possible pre- and post-transplantation risk factors of symptomatic ONFH were investigated and the curative effects of the treatment were also reported.Results The incidence of ONFH was 1.33％ in patients after OLT.ONFH occurred at a mean of (14±6) months (range,10-21 months) after transplantation.Male patients more often presented with osteonecrosis as a complication than female patients.The patients with lower pre-transplantation total bilirubin and direct bilirubin levels (P ＜0.05).There was no difference in the cumulative dose of corticosteroids or tacrolimus between the patients with or without symptomatic ONFH.Patients were treated either pharmacologically or surgically.All patients showed a nice curative effect without major complications during the 18-63 months post-treatment follow up.Conclusions The symptomatic ONFH does not occur commonly after adult OLT in the current individual immunosuppressive protocol in China.