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1,25 Dihydroxyvitamin D circulating levels, calcitriol administration, and incidence of acute rejection, CMV infection, and polyoma virus infection in renal transplant recipients
Author(s) -
Moscarelli Luciano,
Antognoli Giulia,
Buti Elisa,
Dervishi Egrina,
Fani Filippo,
Caroti Leonardo,
Tsalouchos Aris,
Romoli Elena,
Ghiandai Giulia,
Minetti Enrico
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12829
Subject(s) - medicine , calcitriol , immunosuppression , transplantation , renal function , basiliximab , bk virus , incidence (geometry) , kidney transplantation , immunology , kidney , gastroenterology , urology , vitamin d and neurology , physics , optics
Observation that 1,25‐Dihydroxyvitamin‐D3 has an immunomodulatory effect on innate and adaptive immunity raises the possible effect on clinical graft outcome. Aim of this study was to evaluate the correlation of biopsy‐proven acute rejection, CMV infection, BKV infection, with 1,25‐Dihydroxyvitamin‐D3 deficiency and the benefit of calcitriol supplementation before and during the transplantation. Risk factors and kidney graft function were also evaluated. All RTRs received induction therapy with basiliximab, cyclosporine, mycophenolic acid, and steroids. During the first year, the incidence of BPAR (4% vs 11%, P =.04), CMV infection (3% vs 9%, P =.04), and BKV infection (6% vs 19%, P =.04) was significantly lower in users compared to controls. By multivariate Cox regression analysis, 1,25‐Dihydroxyvitamin‐D3 deficiency and no calcitriol exposure were independent risk factors for BPAR (HR=4.30, P <.005 and HR=3.25, P <.05), for CMV infection (HR=2.33, P <.05 and HR=2.31, P =.001), and for BKV infection (HR=2.41, P <.05 and HR=2.45, P =.001). After one year, users had a better renal function: eGFR was 62.5±6.7 mL/min vs 51.4±7.6 mL/min ( P <.05). Only one user developed polyomavirus‐associated nephropathy vs 15 controls. Two users lost their graft vs 11 controls. 1,25(OH)2‐D3 deficiency circulating levels increased the risk of BPAR, CMV infection, BKV infection after kidney transplantation. Administration of calcitriol is a way to obtain adequate 1,25(OH)2‐D3 circulating levels.