Vitamin D deficiency in solid‐organ transplant recipients from a Spanish Mediterranean population

Abstract

Summary Background Solid‐organ transplant recipients (SOTRs) are at risk of developing vitamin D deficiency, mainly caused by reduced sunlight exposure with subsequent low vitamin D synthesis in the skin. Aim To analyse whether SOTRs from a Spanish Mediterranean region were vitamin D‐deficient. Methods This was a cross‐sectional, descriptive and observational study in a transplantation‐specialized Dermatological Unit from a Mediterranean area to determine the calcidiol levels of a cohort of 78 consecutively attending patients not receiving vitamin D supplements. Serum 25(OH)D3 levels were determined and clinical characteristics were collected. Logistic regression analysis was used to analyse variables associated with dichotomized 25(OH)D3 levels (≤ or > 10 ng/mL). Results The cohort comprised 30 lung, 29 kidney and 19 liver transplant recipients. Mean calcidiol was 18 ± 9 ng/mL. Deficiency of 25(OH)D3 was present in 19% of patients, while 68% had insufficient levels and 13% had sufficient levels. Following multivariate logistic regression analysis, the season of blood sampling remained the only predictor of deficient 25(OH)D3 levels. Conclusion Despite living in a mid‐latitude country with sunny weather, our SOTR population was at high risk of developing hypovitaminosis D, especially in autumn/winter. Avoiding sun exposure is important to prevent skin cancer, but careful monitoring of vitamin D status is recommended, with supplementation if hypovitaminosis D is detected.

Vitamin D Deficiency as a Predictor of a High Prevalence of Coronary Artery Disease in Pancreas Transplant Candidates With Type 1 Diabetes

“…Below we will discuss the importance of diagnosing and correcting the VDD in pancreas transplant candidates also in light of the anti-inflammatory and immunomodulatory properties of vitamin D. Indeed, pre-clinical studies have shown that vitamin D may have the potential to promote graft survival and prevent recurrence of autoimmunity, as well as allograft rejection in animal models of syngeneic and allogeneic islet transplantation ( 57 ). Moreover, observational studies have shown that VDD is also highly prevalent after solid organ transplantation (e.g., lung, liver, or kidney transplantation) ( 58 , 59 ). In addition, VDD appears to be an independent risk factor for post-transplant diabetes mellitus (PTDM) after kidney transplantation ( 60 ).…”

Role of vitamin D in regulating COVID-19 severity—An immunological perspective

“…113,114 Anti-inflammatory effects of vitamin D are also implicated in successful organ transplantation. 73,[115][116][117][118] In endotoxin-induced acute respiratory distress syndrome (ARDS), inadequate vitamin D level is associated with increased levels of inflammatory cytokines such as IL-1 and TNF-. 119,120 In contrast to largely beneficial effects of vitamin D, certain infections (e.g., citrobacter and leishmania) were confusingly enhanced or unaffected by vitamin D. Subsequent categoric immunologic studies revealed inhibitory effects of vitamin D on inflammatory T H1 effector subset necessary for pathogen control.…”

“…In the case of HSV‐induced Behcet's inflammatory disease, vitamin D mediates protective, anti‐inflammatory effects through down‐regulation of TLRs 113,114 . Anti‐inflammatory effects of vitamin D are also implicated in successful organ transplantation 73,115–118 . In endotoxin‐induced acute respiratory distress syndrome (ARDS), inadequate vitamin D level is associated with increased levels of inflammatory cytokines such as IL‐1β and TNF‐α 119,120 .…”

How to take the skin cancer risk of your transplant patient seriously

“…This means avoiding heavy sun exposure, seeking shade, wearing protective clothes, hats and/or caps, and use of sun protection creams. However, some OTRs, particularly those with a dark skin type, are at risk of vitamin D deficiency if sun avoidance and sun protection is carried out too rigorously, even in sun‐rich regions . Verbal and written patient information for OTRs should take into account the wide range in skin cancer risk according to skin type, age, type of organ, and other risk factors.…”