Association between 25(OH) vitamin D and graft survival in renal transplanted children.

Abstract

In children, vitamin D deficiency is common after renal transplantation. Besides promoting bone and muscle development, vitamin D has immunomodulatory effects, which could protect kidney allografts. The purpose of this study was to assess the association between vitamin D status and the occurrence of renal rejection. We studied a retrospective cohort of 123 children, who were transplanted at a single institution between September 2008 and April 2019. Patients did not receive vitamin D supplementation systematically. In addition, factors influencing vitamin D status were analyzed using univariate and multivariate analyses. Median 25-hydroxy-vitamin D (25-OH-D) concentration was close to reference values at the time of transplantation (30ng/mL (min-max 5-100)), but rapidly decreased within the first 3months to 19ng/mL (min-max 3-91) (P<.001). The overall acute rejection rate was 7%. The clinical rejection rate (5% vs 9%), subclinical rejection (12% vs 36%), and borderline changes (21% vs 28%) were not statistically different during the follow-up between the 3-month 25-OH-D<20ng/mL and 3-month 25-OH-D>20ng/mL groups. There was a correlation between the 25-OH-D levels and PTH concentration at 3months (r=-.2491, P=.01), but no correlation between the 3-month 25-OH-D and the season of the year (F=0.19, P=.90; F=1.34, P=.27, respectively). Multivariate analyses revealed that age and mGFR at 3months, were independent predictors of mGFR at 12months. Our data show that vitamin D deficiency can develop rapidly after transplantation; vitamin D levels at 3months are not associated with lower mGFR or a higher rejection rate at 1year in children as opposed to adult recipients.