1 Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medical College, New York, NY. 2 Department of Transplantation Medicine, New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY. 3 The Rogosin Institute, New York, NY. 4 Address correspondence to: Thangamani Muthukumar, M.D., Division of Nephrology and Hypertension, Department of Medicine, 525 E 68th St, Box 3, New York, NY 10065.
Transplantation. 2014 Aug 15;98(3):292-9. doi: 10.1097/TP.0000000000000055.
Vitamin D, in addition to its established role in bone metabolism, may regulate the immune system and affect the outcome of allografts.
We identified 351 kidney allograft recipients who had serum levels of 25-hydroxyvitamin D (25[OH]D) measured within the first 30 days of transplantation. We evaluated the relationship between the circulating levels of 25(OH)D and acute cellular rejection (ACR), cytomegalovirus (CMV) disease, BK virus nephropathy, and kidney graft function.
Vitamin D deficiency (circulating levels of 25[OH]D ≤20 ng/mL, defined using The Endocrine Society Clinical Practice 2011 Guideline) was observed in 216 (61.5%) of 351 kidney graft recipients. Vitamin D deficiency was more frequent in female recipients (P=0.007, Fisher exact test) and African American recipients (P<0.001) and was less frequent in preemptive kidney graft recipients (P=0.002). Biopsy-confirmed ACR was more frequent in the vitamin D-deficient group than in the sufficient group (10.2% vs. 3.7%, P=0.04). By multivariable Cox regression analysis, vitamin D deficiency was an independent risk factor for ACR (hazard ratio=3.3, P=0.02). Vitamin D deficiency was not associated with CMV disease, BK virus nephropathy, or kidney allograft function at 1 year. 1,25-Dihydroxyvitamin D3 supplementation initiated within the first 90 days of transplantation was associated with a lesser incidence of ACR compared to no treatment with 1,25-dihydroxyvitamin D3 (5.1% vs. 13.0%, P=0.099).
Vitamin D deficiency is an independent risk factor for development of ACR within the first year of kidney transplantation and 1,25-dihydroxyvitamin D3 supplementation may help reduce the occurrence of ACR in the vitamin D-deficient group.
维生素 D 除了在骨骼代谢中的既定作用外，还可能调节免疫系统并影响同种异体移植物的结局。
我们确定了 351 例肾移植受者，他们在移植后 30 天内检测到血清 25-羟维生素 D（25（OH）D）水平。我们评估了循环 25（OH）D 水平与急性细胞排斥（ACR）、巨细胞病毒（CMV）疾病、BK 病毒肾病和肾移植物功能之间的关系。
351 例肾移植受者中，有 216 例（61.5%）存在维生素 D 缺乏症（定义为循环 25（OH）D 水平≤20ng/ml，采用 2011 年内分泌学会临床实践指南）。女性受者（P=0.007，Fisher 确切检验）和非裔美国人受者（P<0.001）中维生素 D 缺乏症更为常见，而抢先肾移植受者中维生素 D 缺乏症较少（P=0.002）。维生素 D 缺乏组的活检证实 ACR 发生率高于充足组（10.2%比 3.7%，P=0.04）。通过多变量 Cox 回归分析，维生素 D 缺乏是 ACR 的独立危险因素（危险比=3.3，P=0.02）。维生素 D 缺乏与 1 年内 CMV 疾病、BK 病毒肾病或肾移植物功能无关。与不使用 1,25-二羟维生素 D3 治疗相比，移植后 90 天内开始补充 1,25-二羟维生素 D3 与 ACR 发生率较低相关（5.1%比 13.0%，P=0.099）。
维生素 D 缺乏是肾移植后 1 年内发生 ACR 的独立危险因素，1,25-二羟维生素 D3 补充可能有助于减少维生素 D 缺乏组中 ACR 的发生。
