Buyukdemirci S, Oguz EG, Cimen SG, Sahin H, Cimen S, Ayli MD. Vitamin D deficiency may predispose patients to increased risk of kidney transplant rejection. World J Transplant 2022; 12(9): 299-309 [PMID: 36187881 DOI: 10.5500/wjt.v12.i9.299]
Corresponding Author of This Article
Sanem Guler Cimen, Doctor, FEBS, Adjunct Associate Professor, Department of General Surgery, Sağlık Bilimleri Universitesi, Güvenlik Caddesi No 87/6, Ankara 65000, Altındağ, Turkey. sanem.cimen@sbu.edu.tr
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 18, 2022; 12(9): 299-309 Published online Sep 18, 2022. doi: 10.5500/wjt.v12.i9.299
Vitamin D deficiency may predispose patients to increased risk of kidney transplant rejection
Semih Buyukdemirci, Ebru Gok Oguz, Sanem Guler Cimen, Hatice Sahin, Sertac Cimen, Mehmet Deniz Ayli
Semih Buyukdemirci, Department of Internal Medicine, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
Ebru Gok Oguz, Hatice Sahin, Mehmet Deniz Ayli, Department of Nephrology, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
Sanem Guler Cimen, Department of General Surgery, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
Sertac Cimen, Department of Urology, Sağlık Bilimleri Universitesi, Ankara 65000, Altındağ, Turkey
Author contributions: This study was conducted at Ankara Diskapi Research and Training Hospital, affiliated with the Health Sciences University of Turkey; the Departments of Internal Medicine, Nephrology, Urology, and General Surgery were involved in conducting the study; Oguz EG and Ayli MD designed the research; Buyukdemirci S and Cimen SG performed the research; Sahin H collected the data; Cimen S analyzed the data; Cimen SG wrote the paper.
Institutional review board statement: The study protocol was approved by the hospital’s ethical review committee (06.08.2018-no. 53/20) and was carried out in accordance with the Declaration of Helsinki and the Declaration of Istanbul.
Informed consent statement: All the patients provided written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: We opt not to share our data, however if required for research purposes contact to the corresponding author is recommended.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sanem Guler Cimen, Doctor, FEBS, Adjunct Associate Professor, Department of General Surgery, Sağlık Bilimleri Universitesi, Güvenlik Caddesi No 87/6, Ankara 65000, Altındağ, Turkey. sanem.cimen@sbu.edu.tr
Received: April 29, 2022 Peer-review started: April 29, 2022 First decision: May 12, 2022 Revised: June 1, 2022 Accepted: September 8, 2022 Article in press: September 8, 2022 Published online: September 18, 2022 Processing time: 136 Days and 16.3 Hours
Abstract
BACKGROUND
Vitamin D deficiency occurs in more than 80% of kidney transplant recipients. Its immunomodulatory effects can predispose transplant recipients to rejection and chronic allograft nephropathy (CAN). This study determined the association between serum 25 (OH) vitamin D, biopsy-proven allograft rejection, and CAN rates.
AIM
To determine the relationship between serum 25 (OH) vitamin D level and biopsy-proven allograft rejection and CAN rate in renal transplant recipients.
METHODS
Adult renal transplant recipients followed at the clinic between January 2013 and 2018 were included. Recipients requiring graft biopsy due to declined function, hematuria, and proteinuria were reviewed. The two groups were compared regarding collected data, including the biopsy results, immunologic parameters, vitamin D, parathyroid hormone (PTH), phosphorus, albumin levels, and graft function tests.
RESULTS
Fifty-two recipients who underwent graft biopsy met the inclusion criteria. In all, 14 recipients had a vitamin D level > 15 ng/mL (group 1) vs ≤ 15 ng/mL (group 2) in 38. In total, 27 patients had biopsy-proven rejection, and 19 had CAN. There was only 1 recipient with biopsy-proven rejection in group 1, whereas there were 24 patients with rejection in group 2. The rejection rate was significantly higher in group 2 than in group 1 (P < 0.001). Four patients were diagnosed with CAN in group 1 vs fifteen in group 2. There was no significant difference in the CAN rate between the two groups. PTH was higher at the time of graft biopsy (P = 0.009, P = 0.022) in group 1 with a mean of 268 pg/mL. Donor-specific antibodies were detected in 14 (56.0%) of the recipients with rejection. Vitamin D level was 9.7 ± 3.4 ng/mL in the rejection group vs 14.7 ± 7.2 in the non-rejection group; this difference was statistically significant (P = 0.003). The albumin levels were significantly lower in patients with rejection than in those without rejection (P = 0.001). In univariate regression analysis of risk factors affecting rejection, sex, serum vitamin D, phosphorus and albumin were found to have an impact (P = 0.027, P = 0.007, P = 0.023, P = 0.008). In multivariate regression analysis, the same factors did not affect rejection.
CONCLUSION
The serum 25 (OH) vitamin D level in kidney transplant recipients remained low. Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis, this finding was not confirmed by multivariate analysis. Prospective studies are required to determine the effect of serum vitamin D levels on allograft rejection.
Core Tip: This study analyzed the results of 130 kidney transplant recipients. Of the 52 recipients who underwent graft biopsy and met the study inclusion criteria, 14 had a vitamin D level > 15 ng/mL vs ≤ 15 ng/mL in 38. Although low serum vitamin D level emerged as a risk factor for rejection in univariate analysis, this finding was not confirmed by multivariate analysis. Nonetheless, diagnostic and predictive accuracy is limited when a single test is used, and larger-scale prospective clinical studies are needed to clearly discern the effects of serum vitamin D level on the renal allograft rejection rate.
