Effectiveness and Outcomes of Current Practice in Treating Vitamin D Deficiency in Patients Listed for Liver Transplantation

Chaney, Amanda; Heckman, Michael G.; Diehl, Nancy N.; Meek, Shon; Keaveny, Andrew P.

doi:10.4158/ep14416.or

Cited by 19 publications

(16 citation statements)

References 20 publications

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Section: Introductionmentioning

confidence: 99%

“…Vitamin D deficiency (VDD) is endemic among patients with end-stage liver disease listed for transplantation (Abu-Mouch, Fireman, Jarchovsky, Zeina, & Assy, 2011;Chaney, Heckman, Diehl, Meek, & Keaveny, 2015;Stein & Shane, 2011;Zhang et al, 2016). This deficiency has been reported to be as high as 91% (Chaney et al, 2015;Choudhary et al, 2011). Vitamin D (VD) has a number of pleiotropic effects including anti-inflammatory properties; antiapoptosis; antifibrosis; regulation of function in the kidney, heart, and immune system; and it maintains homeostasis by regulation of hormone secretion, cell proliferation, and differentiation (Lai & Fang, 2013).…”

Section: Introductionmentioning

confidence: 99%

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A vitamin D protocol post‐liver transplantation

Grant

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Adults with compromised liver function are inherently deficient and especially vulnerable to the consequences of vitamin D deficiency. Consequences of vitamin D deficiency include liver disease progression, infection, and graft failure. A vitamin D supplementation protocol is proposed to systematically optimize serum vitamin D levels according to guidelines in both pre‐ and post‐liver transplanted patients. Methods This quasiexperimental study included a sample of N = 45 post‐liver transplanted patients taking daily cholecalciferol (vitamin D3) 2500 units for 12 weeks, with a pre‐ and post‐lab measure of serum 25‐hydroxyvitamin D levels at a large academic facility. Conclusions Seventy‐eight percent of patients reached minimum guideline levels using the protocol with an average increase of serum vitamin D of 13.8 ng/mL. Long‐term outcomes of clinical significance may include decreased incidence of acute T‐cell‐mediated graft rejection and infections in the immunocompromised patient. Implications for practice Optimizing vitamin D in vulnerable patient populations such as chronic liver disease and the immunosuppressed posttransplanted patient has the potential to curtail complications of vitamin D deficiency. As a result, nurse practitioners employing a vitamin D protocol can create a favorable impact on patient quality of life, safety, and healthcare spending.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A vitamin D protocol post‐liver transplantation

Grant

2017

Journal of the American Association of Nurse Practitioners

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“…Decreased 25(OH)D levels have also been observed in patients with non-alcoholic fatty liver disease (NAFLD), and several epidemiological and experimental studies suggest that vitamin D might be useful for the treatment of liver fibrosis [ 1 , 2 , 14 , 15 , 16 ]. Interventional studies on vitamin D supplementation in patients with liver diseases are sparse and have shown mixed results on the effects of vitamin D on parameters of mineral metabolism, liver function, and fibrosis [ 1 , 2 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D Concentrations in Cirrhotic Patients: A Randomized Controlled Trial

et al. 2016

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Background: The liver is crucial for 25-hydroxyvitamin D (25(OH)D) metabolism, and vitamin D deficiency is highly prevalent in patients with cirrhosis and predicts adverse outcomes. We aimed to evaluate whether vitamin D supplementation in patients with cirrhosis is effective in increasing 25(OH)D serum concentrations. Secondary outcome measures included liver function tests (aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (GGT), and alkaline phosphatase (AP)), albumin, International Normalized Ratio (INR), bilirubin, the liver fibrosis marker hyaluronic acid, and parameters of mineral metabolism including parathyroid hormone (PTH). Methods: This is a double-center, double-blind, placebo-controlled study conducted from December 2013 to May 2014 at the Medical University of Graz, and the hospital Hoergas-Enzenbach, Austria. We enrolled 36 consecutive patients with cirrhosis and 25(OH)D concentrations below 30 ng/mL. Study participants were randomly allocated to receive either 2800 International Units of vitamin D3 per day as oily drops (n = 18) or placebo (n = 18) for 8 weeks. Results: Thirty-three study participants (mean (SD) age: 60 (9) years; 21% females; 25(OH)D: 15.6 (7.4) ng/mL) completed the trial. The mean treatment effect (95% CI) for 25(OH)D was 15.2 (8.0 to 22.4) ng/mL (p < 0.001). There was no significant effect on any secondary outcome. Conclusions: In this randomized controlled trial, vitamin D supplementation increases 25(OH)D serum concentrations, even in cirrhotic patients.

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“…Physicians might have prescribed an insufficient dose of vitamin D, which could be aggravated by an increased demand (compared to nontransplant patients) to reach normal vitamin D levels. Recent reports indicated that an initial loading dose is beneficial to replenish vitamin D levels . Notably, none of our patients received a loading dose.…”

Section: Discussionmentioning

confidence: 77%

Vitamin D status and risk of infections after liver transplantation in the Swiss Transplant Cohort Study

et al. 2018

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Increasing evidence indicates a role of vitamin D in the immune system affecting response to infections. We aimed to characterize the role of vitamin D status, i.e. deficiency [25-OH vitamin D (25-OHD) <50 nmol/l] and no deficiency (25-OHD ≥50 nmol/l) in incident infections after liver transplantation. In 135 liver transplant recipients, blood samples drawn at time of liver transplantation and 6 months afterwards were used to determine 25-OHD levels. Incident infections episodes were prospectively collected within the Swiss Transplant Cohort Study database. Poisson regression was applied to address associations between vitamin D status and incident infections. Vitamin D deficiency was common at time of transplantation and 6 months afterwards without a significant change in median 25-OHD levels. In univariable analyses, vitamin D deficiency was a risk factor for incident infections in the first 6 months post-transplant incidence rate ratio (IRR 1.52, 95% CI 1.08-2.15, P = 0.018) and for bacterial infections occurring after 6 up to 30 months post-transplant (IRR 2.29, 95% CI 1.06-4.94, P = 0.034). These associations were not detectable in multivariable analysis with adjustment for multiple confounders. Efforts to optimize vitamin D supplementation in liver transplant recipients are needed. Our data question the role of vitamin D deficiency in incident infections.

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Effectiveness and Outcomes of Current Practice in Treating Vitamin D Deficiency in Patients Listed for Liver Transplantation

Cited by 19 publications

References 20 publications

A vitamin D protocol post‐liver transplantation

A vitamin D protocol post‐liver transplantation

Effects of Vitamin D Supplementation on Serum 25-Hydroxyvitamin D Concentrations in Cirrhotic Patients: A Randomized Controlled Trial

Vitamin D status and risk of infections after liver transplantation in the Swiss Transplant Cohort Study

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