Vitamin D and the risk of acute allograft rejection following human liver transplantation

doi:10.1111/j.1478-3231.2009.02154.x

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Wiley InterScience

Liver International

Volume 30 Issue 3, Pages 417 - 44

Published Online: 22 Oct 2009

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The Official Journal of the International Association for the Study of the Liver

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CLINICAL STUDIES

Vitamin D and the risk of acute allograft rejection following human liver transplantation

Davide Bitetto ¹ , Carlo Fabris ¹ , Edmondo Falleti ¹ , Ezio Fornasiere ¹ , Elisa Fumolo ¹ , Elisabetta Fontanini ¹ , Annarosa Cussigh ¹ , Giuseppa Occhino ² , Umberto Baccarani ³ , Mario Pirisi ² and Pierluigi Toniutto ¹

1 DPMSC Medical Liver Transplantation Unit, Internal Medicine, University of Udine, Udine, Italy
2 Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy
3 Department of Surgical Sciences, University of Udine, Udine, Italy

Correspondence
Pierluigi Toniutto, MD, DPMSC, Internal Medicine, Medical Liver Transplantation Unit, University of Udine, Udine, Italy
Tel: +39 0432 559801
Fax: +39 0432 42097
e-mail: pierluigi.toniutto@uniud.it

KEYWORDS

acute cellular rejection • cholecalciferol • liver transplantation

ABSTRACT

Background: Vitamin D may act as an immune modulator in experimental and human organ transplantation, but these data are yet to be confirmed in human liver transplantation (LT).

Aim: This study aimed to assess the relationship between acute liver allograft cellular rejection (ACR) and pretransplant serum vitamin D concentration or post-transplant vitamin D supplementation.

Method: We studied 133 LT recipients who underwent two per protocol allograft biopsies in the early post-operative period, plus on-demand biopsies as clinically indicated. ACR estimate was given according to the Banff scheme in biopsies obtained along two follow-up periods: (a) from the transplant operation to the end of the second month (0–2 months); (b) and from the third month to the end of the eighth month (3–8 months) post-LT.

Results: The median pretransplant serum 25-hydroxyvitamin D concentration was 12.5 ng/ml; 40 patients had concentrations ≤12.5 ng/ml, of whom six had ≤5.0 ng/ml. Seventy-nine recipients received oral vitamin D₃ supplementation to treat post-transplant osteoporosis. In the 0–2 months period, moderate-to-severe rejection episodes were independently associated with cytomegalovirus reactivation (P<0.005) and progressively lower pretransplant serum 25-hydroxyvitamin D concentrations (P<0.02). Early vitamin D₃ supplementation was independently associated with a lack of ACR (P<0.05).

Conclusions: These results suggest that vitamin D may favour immune tolerance towards the liver allograft.

Received 28 July 2009
Accepted 15 September 2009

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1478-3231.2009.02154.x About DOI