1,25 Dihydroxyvitamin D circulating levels, calcitriol administration, and incidence of acute rejection, CMV infection, and polyoma virus infection in renal transplant recipients

Abstract

Observation that 1,25-Dihydroxyvitamin-D3 has an immunomodulatory effect on innate and adaptive immunity raises the possible effect on clinical graft outcome. Aim of this study was to evaluate the correlation of biopsy-proven acute rejection, CMV infection, BKV infection, with 1,25-Dihydroxyvitamin-D3 deficiency and the benefit of calcitriol supplementation before and during the transplantation. Risk factors and kidney graft function were also evaluated. All RTRs received induction therapy with basiliximab, cyclosporine, mycophenolic acid, and steroids. During the first year, the incidence of BPAR (4% vs 11%, P=.04), CMV infection (3% vs 9%, P=.04), and BKV infection (6% vs 19%, P=.04) was significantly lower in users compared to controls. By multivariate Cox regression analysis, 1,25-Dihydroxyvitamin-D3 deficiency and no calcitriol exposure were independent risk factors for BPAR (HR=4.30, P<.005 and HR=3.25, P<.05), for CMV infection (HR=2.33, P<.05 and HR=2.31, P=.001), and for BKV infection (HR=2.41, P<.05 and HR=2.45, P=.001). After one year, users had a better renal function: eGFR was 62.5±6.7 mL/min vs 51.4±7.6 mL/min (P<.05). Only one user developed polyomavirus-associated nephropathy vs 15 controls. Two users lost their graft vs 11 controls. 1,25(OH)2-D3 deficiency circulating levels increased the risk of BPAR, CMV infection, BKV infection after kidney transplantation. Administration of calcitriol is a way to obtain adequate 1,25(OH)2-D3 circulating levels.

Vitamin D deficiency and infection risk in kidney transplant recipients: A single‐center cohort study

“…Biological plausibility was supported by the dose‐response gradient observed between lower quartiles of serum 25(OH)D levels and infection susceptibility, with a 24% decrease in the risk of overall infection per each one‐quartile increase. Our results reinforce recent studies suggesting the clinical relevance of the immunomodulatory role attributable to vitamin D in the setting of ongoing immunosuppression after KT.…”

“…Moreover, more than half of patients lacked vitamin D measurement . Finally, Moscarelli et al measured 1,25(OH) 2 D 3 (calcitriol) at post‐transplant months 1, 6 and 12 and observed a significant association between serum levels <20 pg/mL and the development of CMV or BK viremia.…”

“…Vitamin D deficiency is common among patients with ESRD, and such status may persist after KT . Recent studies have reported an increased risk of infection for vitamin D‐deficient KT recipients . However, many of these studies only assessed baseline vitamin D levels .…”

“…However, many of these studies only assessed baseline vitamin D levels . The study outcomes gathered any type of post‐transplant infection as a single category or were alternatively restricted to specific events . Finally, serum levels of 25‐hydroxyvitamin D (25(OH)D) or calcifediol, the most reliable nutritional marker, were solely analyzed as a dichotomous variable despite the lack of universally accepted optimal values …”

“…21 Recent studies have reported an increased risk of infection for vitamin D-deficient KT recipients. [22][23][24][25][26] However, many of these studies only assessed baseline vitamin D levels. 22,23,25 The study outcomes gathered any type of post-transplant infection as a single category 26 or were alternatively restricted to specific events.…”