A vitamin D protocol post‐liver transplantation

Abstract

Background and purpose Adults with compromised liver function are inherently deficient and especially vulnerable to the consequences of vitamin D deficiency. Consequences of vitamin D deficiency include liver disease progression, infection, and graft failure. A vitamin D supplementation protocol is proposed to systematically optimize serum vitamin D levels according to guidelines in both pre‐ and post‐liver transplanted patients. Methods This quasiexperimental study included a sample of N = 45 post‐liver transplanted patients taking daily cholecalciferol (vitamin D3) 2500 units for 12 weeks, with a pre‐ and post‐lab measure of serum 25‐hydroxyvitamin D levels at a large academic facility. Conclusions Seventy‐eight percent of patients reached minimum guideline levels using the protocol with an average increase of serum vitamin D of 13.8 ng/mL. Long‐term outcomes of clinical significance may include decreased incidence of acute T‐cell‐mediated graft rejection and infections in the immunocompromised patient. Implications for practice Optimizing vitamin D in vulnerable patient populations such as chronic liver disease and the immunosuppressed posttransplanted patient has the potential to curtail complications of vitamin D deficiency. As a result, nurse practitioners employing a vitamin D protocol can create a favorable impact on patient quality of life, safety, and healthcare spending.

Pleiotropic Effect of Vitamin D in Cystic Fibrosis

“…What is important, this risk persisted if the level of hydroxyvitamin D did not improve in a year after surgery and had consequences in low patients survival. Moreover, similar results in the prognosis of patients with hypovitaminosis D were found after liver transplantations [27].…”

Nutritional Strategies to Manage Malnutrition and Sarcopenia following Liver Transplantation: A Narrative Review

“…Vitamin D, a fat-soluble vitamin, plays an important role in bone metabolism, regulates gene expression in multiple tissues, and increases calcium intestinal absorption [ 91 ]. Vitamin D deficiency is present in 91% of LT recipients [ 92 ]. While LT has been reported to improve serum vitamin D concentrations, glucocorticoid therapy in the three to six months post-LT could result in vitamin D deficiency [ 93 ].…”

The Role of Vitamin Deficiency in Liver Disease: To Supplement or Not Supplement?

“…Bitetto et al, assuming that vitamin D acts as an immunomodulator in their experimental transplantation, examined 133 transplanted patients and concluded that vitamin D could promote immune tolerance towards liver allografts [178]. In a recent study on a small sample of post-liver transplantation patients who received supplements of cholecalciferol (vitamin D 3 ) at 2500 units per day for 12 weeks, 78% of them benefited from the treatment, with a decrease in the incidence of transplantation rejection as well as infections in these immuno-compromised patients [179]. More recently, another study confirmed the above-mentioned evidence of the beneficial role of Vitamin D supplements, which is associated with a lower risk of acute rejection and infections and promotes immune tolerance towards liver allografts through the involvement of regulatory T cells [180] and finally, by reducing hepatocyte apoptosis [181,182].…”