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Evaluation of Vitamin D Levels in Children With Liver Transplant
Murat Gülşen1, Figen Özçay, Zeren Barış
1From the Department of Pediatrics, Etlik City Hospital, Ankara, Turkey.
Insights
Vitamin D deficiency is common in pediatric liver disease patients before and after liver transplant. Supplementation is recommended, though vitamin D levels did not correlate with graft rejection or survival.
Area of Science:
- Pediatric Hepatology
- Transplantation Medicine
- Nutritional Science
Background:
- Vitamin D deficiency is a significant concern in pediatric chronic liver disease.
- Oral vitamin D replacement often proves insufficient in these patients.
Purpose of the Study:
- To evaluate vitamin D levels in pediatric liver transplant recipients before and after transplantation.
- To investigate the relationship between pre- and post-transplant vitamin D status and liver graft rejection.
Main Methods:
- A cohort of 138 pediatric liver transplant recipients was studied.
- Vitamin D levels, liver function tests, and rejection scores were analyzed.
- Patients were categorized by underlying liver disease: cholestatic, cirrhosis, metabolic, and acute liver failure.
Main Results:
- Prevalence of vitamin D deficiency was high both before (40% within range) and after (58.7% within range) transplant.
- Post-transplant vitamin D levels were significantly higher than pre-transplant levels.
- Lower pre-transplant vitamin D was observed in cholestatic liver disease, improving post-transplant. No correlation found with rejection or survival.
Conclusions:
- Vitamin D deficiency persists in pediatric liver transplant recipients, particularly those with cholestatic conditions.
- Vitamin D levels were not associated with liver graft rejection or patient survival.
- Close monitoring and tailored vitamin D supplementation are advised pre- and post-transplant.
Objectives:
Vitamin D deficiency is common in pediatric chronic liver disease despite oral replacement. We evaluated vitamin D deficiency before and after liver transplant and the relationship between posttransplant and pretransplant vitamin D deficiency and graft rejection.
Materials And Methods:
Pediatric recipients with chronic liver disease (N =138) were divided into 4 groups: cholestatic liver diseases, cirrhosis, metabolic disorders, and acute liver failure. Pretransplant and posttransplant vitamin D levels, liver function tests, Pediatric End-Stage Liver Disease scores, rejection activity index scores by graft liver biopsy, and posttransplant patient survival were recorded.
Results:
There were 62 (45%) female and 76 (55%) male participants (mean transplant age, 6.1 ± 5.6 years). Pretransplant mean available vitamin D of 90 patients was 25.2 ± 20.9 ng/mL, with 36 (40%) within reference range. Posttransplant level for 109 patients was 27.3 ± 18 ng/mL, with 64 (58.7%) within reference range. Pretransplant and posttransplant levels were available for 61 patients, and mean pretransplant levels were lower than posttransplant levels (23.7 ± 19.3 vs 28.3 ± 16.9 ng/mL; P = .01). Patients with cholestatic liver disease had lower pretransplant vitamin D levels (P = .04), which disappeared after transplant. Pretransplant vitamin D levels were positively correlated with serum albumin levels (r = 0.20) in all patients and negatively correlated with total/direct bilirubin (r = 0.29 and r = -0.30) in those with liver diseases and cirrhosis. No correlations were found between pretransplant vitamin D levels and Pediatric End-Stage Liver Disease scores, rejection activity index scores, and posttransplant mortality.
Conclusions:
Vitamin D deficiency is prevalent in pediatric chronic liver disease before and after transplant, especially for cholestatic liver diseases. However, no association between vitamin D levels and liver graft rejection or patient survival was noted. We recommend close monitoring and individualized vitamin D supplementation before and after liver transplant.
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