Kidney360 · 2025
Association of Post-Transplant Circulating 25-Hydroxyvitamin D and Long-Term Patient and Graft Outcomes among Kidney Transplant Recipients: The Wisconsin Allograft Recipient Database.
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Yuan Zhongyu, Parajuli Sandesh, Mandelbrot Didier, Melamed Michal L, Astor Brad C
Аннотация
KEY POINTS: Vitamin D insufficiency is associated with higher risk of death-censored graft failure and infection-related mortality after kidney transplantation. Vitamin D insufficiency is associated with a faster decline of graft function after kidney transplantation.
BACKGROUND: Vitamin D inadequacy at or shortly after kidney transplantation is associated with poor outcomes. Circulating 25-hydroxyvitamin D [25(OH)D] levels generally increase over time after transplantation, but inadequacy remains common. Few studies have examined associations of later circulating 25(OH)D levels and long-term outcomes.
METHODS: We analyzed data from the Wisconsin Allograft Recipient Database to assess the association of post-transplant 25(OH)D with overall graft failure, death-censored graft failure (DCGF), death with a functioning graft, cause-specific mortality, and eGFR trajectory over the next 4 years.
RESULTS: A total of 2504 recipients who maintained a functioning graft for at least 13 months were included in our analysis. A total of 867 overall graft failures occurred during a median follow-up of 6.8 years. Vitamin D deficiency (≤20 ng/ml) was associated with a 43% higher hazard of overall graft failure (95% confidence interval [CI], 1.16 to 1.78), a 2.24-fold higher hazard of DCGF (95% CI, 1.60 to 3.12), and a 2.10-fold higher hazard (95% CI, 1.37 to 3.21) of infection-related mortality compared with sufficiency. It also was associated with a 1.38 ml/min per 1.73 m2 per year faster (95% CI, −1.97 to −0.79) annual eGFR decline compared with sufficiency. No association was detected for death with a functioning graft or other cause-specific mortality.
CONCLUSIONS: In conclusion, post-transplant vitamin D deficiency is associated with a higher risk of DCGF, infection-related mortality, and a faster decline of graft function in kidney transplant recipients.
BACKGROUND: Vitamin D inadequacy at or shortly after kidney transplantation is associated with poor outcomes. Circulating 25-hydroxyvitamin D [25(OH)D] levels generally increase over time after transplantation, but inadequacy remains common. Few studies have examined associations of later circulating 25(OH)D levels and long-term outcomes.
METHODS: We analyzed data from the Wisconsin Allograft Recipient Database to assess the association of post-transplant 25(OH)D with overall graft failure, death-censored graft failure (DCGF), death with a functioning graft, cause-specific mortality, and eGFR trajectory over the next 4 years.
RESULTS: A total of 2504 recipients who maintained a functioning graft for at least 13 months were included in our analysis. A total of 867 overall graft failures occurred during a median follow-up of 6.8 years. Vitamin D deficiency (≤20 ng/ml) was associated with a 43% higher hazard of overall graft failure (95% confidence interval [CI], 1.16 to 1.78), a 2.24-fold higher hazard of DCGF (95% CI, 1.60 to 3.12), and a 2.10-fold higher hazard (95% CI, 1.37 to 3.21) of infection-related mortality compared with sufficiency. It also was associated with a 1.38 ml/min per 1.73 m2 per year faster (95% CI, −1.97 to −0.79) annual eGFR decline compared with sufficiency. No association was detected for death with a functioning graft or other cause-specific mortality.
CONCLUSIONS: In conclusion, post-transplant vitamin D deficiency is associated with a higher risk of DCGF, infection-related mortality, and a faster decline of graft function in kidney transplant recipients.