Vitamin D and the risk of acute allograft rejection following human liver transplantation

Bitetto, Davide; Fabris, Carlo; Falleti, Edmondo; Fornasiere, Ezio; Fumolo, Elisa; Fontanini, Elisabetta; Cussigh, Annarosa; Occhino, G.; Baccarani, Umberto; Pirisi, Mario; Toniutto, Pierluigi

doi:10.1111/j.1478-3231.2009.02154.x

Cited by 85 publications

(75 citation statements)

References 33 publications

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“…Several observational studies indicate associations between vitamin D deficiency and disorders of the immune system, such as multiple sclerosis, 33 type 1 diabetes, 34 rheumatoid arthritis 35 and rejection of solid organ allografts. 36 Some studies have also shown beneficial effects of vitamin D supplementation, most notably in the prevention of type 1 diabetes, 37 and amelioration of symptoms of multiple sclerosis by treatment with high dose vitamin D. 38 However, the relevance of these findings is questioned due to the lack of prospective, randomized trials. Such trials are difficult to carry out in diseases with low incidence and slow onset, such as diabetes type 1.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Bahr

Blennow

Alm

et al. 2015

Bone Marrow Transplant

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Vitamin D has emerged as a central player in the immune system, with its deficiency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were deficient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identified as a significant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-deficient patients. In addition, we found a significant correlation between vitamin D deficiency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufficient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These findings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of vitamin D supplementation are therefore needed.

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Section: Discussionmentioning

confidence: 99%

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Bahr

Blennow

Alm

et al. 2015

Bone Marrow Transplant

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“…27,28 Our findings appear to be in keeping with results published in renal and liver transplantation, where low vitamin D levels have been associated with an increased risk of rejection of transplanted organs. 29,30 In renal transplant recipients, patients receiving vitamin D supplementation had a significant reduction in acute rejection episodes and graft loss. 31 Conversely, vitamin D deficiency has been associated with an increase in allo-reactive T cells in patients undergoing hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Low levels of 25-hydroxyvitamin D before allogeneic hematopoietic SCT correlate with the development of chronic GVHD

Glotzbecker

Aldridge

et al. 2012

Bone Marrow Transplant

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Vitamin D, a hormone involved in bone and calcium homeostasis, has been shown to have potent immunomodulatory effects. We performed a retrospective cohort analysis to evaluate whether monohydroxyvitamin D levels before allogeneic hematopoietic SCT (HSCT) correlate with the risk of GVHD. Fifty-three patients who underwent myeloablative HSCT were studied. Vitamin D levels were measured in serum samples obtained before HSCT. The median 25-hydroxyvitamin vitamin D level was 21.9 ng/mL (7.8-45.7). The cumulative incidence (CI) of grades II-IV acute GVHD at 100 days was 53.1% in patients with vitamin Do25, versus 33.3% in patients with vitamin DX25 ng/mL (P ¼ 0.13). The CI of chronic GVHD (cGVHD) at 2 years in patients with vitamin Do25 was 63.8%, compared with 23.8% in patients with vitamin DX25 ng/mL (P ¼ 0.009). Similarly, the 2 year CI of extensive cGVHD was significantly greater in patients with vitamin Do25 compared with those with vitamin DX25 ng/mL (54.5% versus 14.3%, P ¼ 0.005). In a multivariable competing risk model, low pre-transplant vitamin D levels remained a significant factor associated with cGVHD (hazard ratio ¼ 5.26, P ¼ 0.02). Our results demonstrate that vitamin D deficiency before HSCT is associated with an increased risk of cGVHD. (2013) 48, 593-597; doi:10.1038/bmt.2012 published online 24 September 2012 Keywords: Vitamin D; GVHD; hematopoietic SCT INTRODUCTION GVHD remains a significant cause of morbidity and mortality following allogeneic HSCT. Despite standard immune-suppression with a calcineurin inhibitor and MTX, grade II-IV acute GVHD rates range from 20-50% and chronic GVHD from 40-50% after BMT. Bone Marrow Transplantation

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“…However, in our clinical trial of heart transplant recipients treated with calcitriol, we did not observe a reduction in cyclosporine or prednisone dose [14]. In a retrospective study, patients with lower pre-operative 25(OH)D had more frequent moderate to severe rejection episodes in the first 2 months after cardiac transplantation [15]. In a clinical non-experimental setting, patients who were supplemented with cholecalciferol (vitamin D 3 ) had fewer rejection episodes [15].…”

Section: Role Of Vitamin D In Allograft Rejectionmentioning

confidence: 67%

“…In a retrospective study, patients with lower pre-operative 25(OH)D had more frequent moderate to severe rejection episodes in the first 2 months after cardiac transplantation [15]. In a clinical non-experimental setting, patients who were supplemented with cholecalciferol (vitamin D 3 ) had fewer rejection episodes [15]. Further prospective human studies are needed to explore the role of 1,25(OH) 2 D and of parent vitamin D in prevention of graft rejection and infection after transplantation.…”

Section: Role Of Vitamin D In Allograft Rejectionmentioning

confidence: 99%

Vitamin D and Organ Transplantation

Stein

Shane

2011

Vitamin D

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Vitamin D and the risk of acute allograft rejection following human liver transplantation

Abstract: These results suggest that vitamin D may favour immune tolerance towards the liver allograft.

Cited by 85 publications

References 33 publications

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Low levels of 25-hydroxyvitamin D before allogeneic hematopoietic SCT correlate with the development of chronic GVHD

Vitamin D and Organ Transplantation

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