Vitamin D Insufficiency Prior to Paediatric Liver Transplantation Is Associated with Early T-Cell Mediated Rejection

Area of Science:

• Immunology
• Endocrinology
• Transplantation

Background:

• T-cell mediated rejection (TCMR) poses a significant threat to long-term liver allograft survival.
• Vitamin D possesses immunomodulatory properties that are gaining recognition.
• Pre-transplant factors influencing post-transplant outcomes are crucial for optimizing patient care.

Purpose of the Study:

• To investigate the association between vitamin D metabolism perturbations before liver transplantation (LT) and the incidence of TCMR in pediatric recipients.
• To determine if pre-LT vitamin D insufficiency is a risk factor for TCMR in children undergoing liver transplantation.
• To explore potential correlations between parathyroid hormone (PTH) levels and TCMR.

Main Methods:

• Retrospective single-center study analyzing data from pediatric liver transplant recipients between 2005 and 2017.
• Collection of serum 25(OH) vitamin D levels and other vitamin D metabolism parameters prior to LT.
• Review of post-transplant variables within the first year following LT from medical records.

Main Results:

• Of 82 pediatric patients, 26 (32%) developed TCMR.
• Vitamin D insufficiency was observed in 65% of patients pre-LT.
• TCMR development was significantly associated with pre-LT vitamin D insufficiency (p = 0.01), particularly in those transplanted for cholestatic diseases (p = 0.004).

Conclusions:

• Pre-transplant vitamin D insufficiency may be linked to an increased risk of TCMR in the first year after pediatric liver transplantation.
• These findings suggest that optimizing vitamin D status before LT could be a potential strategy to reduce TCMR.
• Further research is warranted to confirm these associations and explore therapeutic interventions.