title: Calcitriol deficiency and 1-year mortality in cardiac transplant recipients.
abstract: BACKGROUND
  Administration of the vitamin D hormone calcitriol improves survival in solid-organ transplanted experimental animals. We investigated whether lower serum calcitriol concentrations are associated with increased 1-year mortality in cardiac transplant recipients.
  
  
  METHODS
  We prospectively recruited 171 patients who underwent cardiac transplantation at out institution between May 2004 and April 2006. We assessed calciotropic hormones, inflammation markers, and renal function preoperatively and on postoperative days 6 (t1) and 21 (t2).
  
  
  RESULTS
  Serum creatinine and C-reactive protein increased, whereas calcitriol decreased significantly after transplantation (P<0.001). As determined by multivariable Cox regression analysis, the calcitriol level at t2 was an independent predictor of 1-year mortality. One-year mortality was 3.7 per 100 person-years in the tertile with the highest calcitriol concentrations at t2 (> 18 pg/mL), 13.2 per 100 person-years in the intermediate tertile (11-18 pg/mL), and 32.1 per 100 person-years in the tertile with the lowest calcitriol concentrations at t2 (< 11 pg/mL) (P<0.001). 25-Hydroxyvitamin D deficiency (serum concentrations below 10 ng/mL), renal insufficiency (serum creatinine > or = 1.6 mg/dL), and high serum concentrations of the inflammation markers C-reactive peptide and tumor necrosis factor-alpha were predictors of a serum calcitriol concentration below 11 pg/mL (P=0.037-0.001).
  
  
  CONCLUSIONS
  Low postoperative calcitriol concentrations are independently associated with high 1-year mortality in cardiac transplant recipients. A causal relationship has yet to be proven by intervention trials using active vitamin D.
authors.affiliation: Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr Universität Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany. azittermann@hdz-nrw.de
authors.forename: Armin
authors.initials: A
authors.lastname: Zittermann
authors.forename: Stefanie S
authors.initials: SS
authors.lastname: Schleithoff
authors.forename: Christian
authors.initials: C
authors.lastname: Götting
authors.forename: Uwe
authors.initials: U
authors.lastname: Fuchs
authors.forename: Joachim
authors.initials: J
authors.lastname: Kuhn
authors.forename: Knut
authors.initials: K
authors.lastname: Kleesiek
authors.forename: Gero
authors.initials: G
authors.lastname: Tenderich
authors.forename: Reiner
authors.initials: R
authors.lastname: Koerfer
mesh_terms: D015415:Biomarkers / Q000097:blood; D002117:Calcitriol / Q000097:blood / Q000172:deficiency*; D002118:Calcium / Q000097:blood; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002117:Calcitriol; D002118:Calcium