Vitamin D levels in liver transplantation recipients and early postoperative outcomes: Prospective observational DLiverX study

Abstract

In critically ill patients with liver disease, vitamin D deficiency is associated with higher disease severity, increased frequency of infections, and worse outcomes. This study sought to describe the trend of vitamin D in orthotopic liver transplantation (OLT) recipients and its association with outcomes. Prospective observational study of 67 consecutive OLT recipients enrolled between September, 2016 and August, 2017at IRCCS-ISMETT, Palermo (Italy). Trend of vitamin D levels and potential factors influencing it levels were evaluated through a generalized linear mixed regression model. Sixty-four (95.5%) recipients were vitamin D deficient (<20ng/ml), with a median value of 8.8ng/ml [6.2-12.9], and forty-seven of these (70.1%) showed severe deficiency (<12ng/ml) at baseline, 7.9ng/ml [5.4-8.9]. The baseline vitamin D showed an inverse correlation with liver disease severity: Child-Pugh, MELD score, bilirubin, INR, and organ failure (p<0.01) at baseline. Vitamin D increased on postoperative day (POD) 28 compared with POD1:+4.5ng/ml, C.I. 95% 3.6-5.3ng/ml, p<0.01. Lower baseline vitamin D, donor age, transfusion of fresh frozen plasma (negative impact, all p<0.05), and intra-operative bypass (positive impact at POD 28, p<0.01) were associated with variation of vitamin D levels after transplantation. Incomplete graft recovery was associated with lower vitamin D on POD28: 8.2±4.4 versus 13.8±9.4ng/ml, p<0.01; the odds ratio (OR) was 0.84; CI 95% 0.73-0.97, p=0.014. The OR for infections within POD 28 was inversely associated with baseline vitamin D: 0.87; CI 95% 0.79-0.98, p=0.02, and with vitamin D level at baseline <12ng/ml: OR 6.44; CI 95% 1.66-24.94; p<0.01. Preoperative Vitamin D is correlated with disease severity, and was highly associated with invasive infection in the first 28 PODs. After OLT, the value on POD 28 had a strong association with graft function.