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Abstract
Objectives: T-cell mediated rejection (TCMR) can compromise long-term liver allograft survival. The immunomodulatory properties of vitamin D are increasingly recognized. We investigated whether perturbations in vitamin D metabolism prior to LT may predispose to TCMR in a representative cohort of paediatric LT recipients. Methods: In this retrospective single-center study of children who underwent liver transplantation between 2005 and 2017, we collected serum 25(OH) vitamin D levels and other parameters related to vitamin D metabolism. Post-transplant variables were collected from medical records during the first year following LT. Results: Eighty-two patients were included. Twenty-six (32%) developed TCMR, 52 (65%) presented at least one event of 25(OH) D insufficiency during the year before the transplant, while 23 (32%) had at least one documented elevated plasma parathyroid hormone level. Forty-six patients benefited from nutritional support (56%). The development of TCMR was associated with vitamin D insufficiency pre-LT (p = 0.01). No significant correlations were identified between PTH levels and incidence of TCMR. The association was stronger in patients transplanted for cholestatic diseases (p = 0.004). Conclusions: Vitamin D insufficiency before a liver transplant may be associated with TCMR during the first year post-LT. These findings warrant further investigation.
Highlights
Liver transplantation (LT) is the standard of care for children with end-stage liver disease [1]
We investigated whether perturbations in vitamin D metabolism prior to LT may predispose to T-cell mediated rejection (TCMR) in a representative cohort of paediatric LT recipients
Because of the immunomodulatory role of vitamin D, we hypothesized that pre LT 25(OH) D levels may predispose to TCMR
Summary
Liver transplantation (LT) is the standard of care for children with end-stage liver disease [1]. Cholestasis is the most frequent indication for paediatric LT and is frequently associated with profound fat-soluble vitamin malabsorption, and consequent vitamin D insufficiency [2]. Paediatric LT may differ from adult LT by its comparatively higher frequency of T-cell mediated rejection (TCMR) [3,4]. The immunomodulatory role of vitamin D has been increasingly highlighted. Vitamin D supplementation and vitamin D sufficiency have been reported to be associated with rejection after solid organ transplantation [5,6,7,8,9,10,11]. The relationship between vitamin D deficiency and the onset of autoimmune diseases, such as multiple sclerosis or rheumatoid arthritis, is increasingly documented [12]
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