Low 25(OH) Vitamin-D levels are associated with inferior graft function in living related kidney transplant recipients

Abstract

Introduction: Vitamin D deficiency can impact post-transplant outcomes due to its effect on graft function and rejection. The effect of pre-and post-transplant serum vitamin D levels was evaluated on graft function. Objectives: This study aims to determine the incidence of vitamin D deficiency and its effect on post kidney transplant allograft function in a North Indian cohort. Patients and Methods: We evaluated 57 patients on dialysis, going for transplantation. Estimated glomerular filtration rate (eGFR) was measured using modification of diet in renal disease (MDRD) formula at 2 weeks and 3, 6, 12 months interval after kidney transplantation. Results: Pre-and post-transplant (3 months) vitamin D levels were evaluated for vitamin D deficiency and graft function. Before transplant vitamin D levels were 25.77 ± 13.68 ng/mL, 40.4% of these recipients had vitamin D deficiency (levels <20 ng/mL). After transplant, vitamin D levels at 3 months were 22.08 ± 11.15 ng/mL and 54.4% of recipients had vitamin D deficiency. No patient was on vitamin D supplementation after transplantation. At 3 months post-transplant, recipients with vitamin D levels <20 ng/mL, had significantly lower eGFR and higher serum creatinine value as compared to the group with vitamin D levels >20ng/mL. Recipients were divided into 3 groups based on pre-and post-transplant vitamin D levels (<20, 20-30 and >30ng/mL). Pre-transplant vitamin D levels correlated with graft function at 14 days. On multiple regression analysis, 3-month post-transplant vitamin D levels correlated with 12 months eGFR. There was increased incidence of acute rejection episodes in vitamin D deficiency group. Conclusion: There is a high incidence of vitamin D deficiency and insufficiency in kidney transplant recipients. Low levels of post-transplant vitamin D levels at 3 months were associated with inferior allograft function (eGFR) at 1 year.

The Role of Vitamin D in Kidney Transplantation Outcomes: A Systematic Review

“…Out of these 196 articles 40 were eligible for full-text analysis. Ultimately, sixteen articles were included in this review [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] ( Figure 1 ). The rest of the articles were excluded as the design, protocol and/or methodology used investigated a different PICO question to those of our study.…”

“…Four studies [ 24 , 25 , 29 , 30 ] included patients that received vitamin D supplementation therapy (interventional group) and two of them [ 25 , 29 ] did not measure vitamin D levels to distinguish between sufficient and deficient patients. Eight studies [ 19 , 21 , 22 , 23 , 24 , 26 , 27 , 30 ] divided patients into two groups (sufficient and deficient) using various cutoff values and timing of measuring vitamin D levels. Five studies [ 16 , 17 , 18 , 20 , 28 ] divided patients into three groups (deficient, insufficient and sufficient) while one study [ 31 ] further subdivided insufficiency into mild and moderate.…”

“…These mainly included the estimated glomerular filtration rate (eGFR) and serum creatinine to assess graft function, episodes of acute rejection, proteinuria, viral infections, overall graft survival and mortality ( Table 2 ). Nine studies [ 16 , 18 , 19 , 20 , 21 , 23 , 24 , 26 , 30 ] showed a negative effect of vitamin D deficiency in patients’ eGFR and/or serum creatinine at various time cut-offs. Four studies [ 19 , 22 , 28 , 30 ] showed a higher incidence of episodes of acute rejection in patients with vitamin D deficiency while only one [ 17 ] showed no association between the two.…”

The association between vitamin D and acute rejection in human kidney transplantation: A systematic review and meta-analysis study

“…VitD de ciency (VitD < 20 ng/ml) ( 14) is associated with several immune and non-immune diseases and disorders, including multiple sclerosis, rheumatoid arthritis, respiratory infection (3), cystic brosis (15), cardiovascular (16), and hematological diseases (17). Moreover, in the eld of transplantation (kidney transplantation), some studies reported that VitD de ciency remarkably increases the risk of acute rejection (18,19), while others did not indicate such a risk (20,21). Since VitD de ciency is more common in the kidney transplant recipients compared with the general population (19,22), and there is no consistency regarding the association between VitD concentrations and acute rejection, we aimed to carry out the rst systematic review and meta-analysis to clarify whether VitD-de cient patients are more susceptible to acute rejection.…”

The Association Between Vitamin D and Acute Rejection in Human Kidney Transplantation: A Systematic Review and Meta-analysis Study

“…VitD de ciency (VitD < 20 ng/ml) (14) is associated with several immune and non-immune diseases and disorders, including multiple sclerosis, rheumatoid arthritis, respiratory infection (3), cystic brosis (15), cardiovascular (16), and hematological diseases (17). Moreover, in the eld of transplantation (kidney transplantation), some studies reported that VitD de ciency remarkably increases the risk of acute rejection (18,19), while others did not indicate such a risk (20,21). Since VitD de ciency is more common in the kidney transplant recipients compared with the general population (19,22), and there is no consistency regarding the association between VitD concentrations and acute rejection, we aimed to carry out the rst systematic review and meta-analysis to clarify whether VitD-de cient patients are more susceptible to acute rejection.…”