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Vitamin D deficiency may be an independent risk factor for kidney transplant rejection

Posted on: May 22, 2014   by  Niamh Aspell

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New research published in Journal of Clinical and Translational Research identified vitamin D deficiency as a possible risk factor for the susceptibility of kidney transplant patients to transplant rejection.

Through recent research, the regulatory potential of vitamin D on the immune system and its link with autoimmune diseases has become clearer. Researchers are now becoming interested in if vitamin D plays a role in immuno-compromised organ transplant patients and the increased risk of acute cellular rejection (ACR).

ACR is when the transplanted tissue is rejected by the recipient’s immune system. It is a major complication after kidney transplantation. The long term graft success after treatment of ACR is not promising and remains a major risk factor for chronic transplant dysfunction.

Research to date on vitamin D and ACR has been limited to observational studies and the results have been inconsistent.

In a new study, scientists from Weill Cornell Medical College, New York, conducted a retrospective analysis of kidney transplant recipients, using the Endocrine Society Consensus guidelines which define vitamin D deficiency as a level lower than 20 ng/ml in order to reveal a potential relationship.

The researchers identified 1,211 kidney transplant recipients, of which 351 had circulating vitamin D levels measured within the first 30 days after transplantation was performed at Weill Cornell Medical Center in New York.

Furthermore, 133 patients who were vitamin D deficient were prescribed varying amounts of vitamin D2 or D3 supplements within the first 90 days by their physician.

The researchers wanted to investigate possible correlations between post-transplant vitamin D status, the incidence of ACR during the first year of transplantation, and kidney function after 1 year, using the incidence of biopsies to confirm ACR.

Here’s what the researchers found:

  • 27 of the 351 patients developed ACR, and the incidence was significantly higher in those who were vitamin D deficient (P=0.04).
  • Vitamin D deficiency was an independent risk factor for ACR (P=0.02).
  • Vitamin D status was not associated with post-transplant viral infections or kidney function 12 months post-transplantation.

The researchers concluded:

“The findings from this study that vitamin D deficiency is associated with ACR and that supplementation with vitamin D may reduce this risk suggest that issues related to screening vitamin D levels in the post transplantation period and treatment in those found to be vitamin D deficit require evaluation in properly designed clinical trials.”

The research conducted shows an interesting correlation between vitamin D levels and increased risk of ACR in kidney transplant patients. However it is disappointing that no associations were found in regards to post-transplant diseases. One possible reason for this may be due to the small number of events occurring in this study cohort.

Continual research using consistent vitamin D supplement dosage in larger populations should help address the limitations of this study and may potentially inform future screening procedures and supplementation programs for kidney transplant recipients.

Source

Lee JR et al. Circulating levels of 25-hydroxyvitamin D and acute cellular rejection in kidney allograft recipients. The Journal of Clinical and Translational Research, 2014.

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