Nutrition Support in Liver Transplantation and Postoperative Recovery: The Effects of Vitamin D Level and Vitamin D Supplementation in Liver Transplantation.

K V Narayanan Menon,Kazunari Sasaki,Koji Hashimoto,Masato Fujiki,Amika Moro,Bijan Eghtesad,Junshi Doi,Cristiano Quintini

doi:10.3390/nu12123677

K V Narayanan Menon, Kazunari Sasaki + Show 6 more

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https://doi.org/10.3390/nu12123677

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Journal: Nutrients	Publication Date: Nov 28, 2020
Citations: 12	License type: CC BY 4.0

Affiliation: Cleveland Clinic

Abstract

Vitamin D plays an important role in the arena of liver transplantation. In addition to affecting skeletal health significantly, it also clinically exerts immune-modulatory properties. Vitamin D deficiency is one of the nutritional issues in the perioperative period of liver transplantation (LT). Although vitamin D deficiency is known to contribute to higher incidences of acute cellular rejection (ACR) and graft failure in other solid organ transplantation, such as kidneys and lungs, its role in LT is not well understood. The aim of this study was to investigate the clinical implication of vitamin D deficiency in LT. LT outcomes were reviewed in a retrospective cohort of 528 recipients during 2014–2019. In the pre-transplant period, 55% of patients were vitamin-D-deficient. The serum vitamin D level was correlated with the model for end-stage liver disease (MELD-Na) score. Vitamin D deficiency in the post-transplant period was associated with lower survival after LT, and the post-transplant supplementation of vitamin D was associated with a lower risk of ACR. The optimal vitamin D status and vitamin D supplementation in the post-transplant period may prolong survival and reduce ACR incidence.

Highlights

Vitamin D plays an important role in bone metabolism, regulating gene expression in multiple tissues, and increasing the intestinal absorption of calcium
We demonstrated that vitamin D supplementation in the post-transplant period has positive effects in decreasing the incidence of acute cellular rejection (ACR) during one year after liver transplantation (LT)
Vitamin D deficiency in the post-transplant period was associated with lower survival after

Summary

Introduction

Vitamin D plays an important role in bone metabolism, regulating gene expression in multiple tissues, and increasing the intestinal absorption of calcium. In addition to the well-known effects on musculoskeletal metabolism, it has been reported that vitamin D has anti-inflammatory and immune-modulatory properties [1,2,3]. Low serum levels of vitamin D have been associated with a higher prevalence of infections, cancer, cardiovascular, and autoimmune disorders [4,5]. Due to the end-stage liver disease (ESLD) of the LT patients, malabsorption, inadequate dietary intake, and impairment in hepatic activation of vitamins are major issues [7,8]. While LT has been reported to have positive effects in increasing serum vitamin D concentrations as well as the percentage of patients with sufficient vitamin D levels, immunosuppression-related metabolic disturbances cause vitamin D

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