title: Changes in vitamin D binding protein and vitamin D concentrations associated with liver transplantation.
abstract: BACKGROUND
  Vitamin D deficiency is associated with fractures, infections and death. Liver disease impairs vitamin D and vitamin D binding protein (DBP) metabolism.
  
  
  OBJECTIVE
  We aimed to determine the impact of liver transplantation on vitamin D, particularly on DBP and free vitamin D concentrations.
  
  
  METHODS
  Serum 25(OH)D, 1,25(OH)(2) D and DBP concentrations were measured in 202 adults before liver transplantation and 3 months later in 155. Free vitamin D concentrations were estimated from these values. Risk factors for 25(OH)D deficiency (<20 ng/ml) and low 1,25(OH)(2) D (<20 pg/ml) were examined with logistic regression, and changes in concentrations following transplantation with linear regression.
  
  
  RESULTS
  Pretransplant, 84% were 25(OH)D deficient, 13% had 25(OH)D concentrations <2.5 ng/ml, and 77% had low 1,25(OH)(2) D. Model for end-stage liver disease score ≥ 20 (P < 0.005) and hypoalbuminemia (P < 0.005) were associated with low 25(OH)D and 1,25(OH)(2) D concentrations. Following transplantation, 25(OH)D concentrations increased a median of 17.8 ng/ml (P < 0.001). Albumin increased from a median of 2.7 to 3.8 g/dl (P < 0.001) and DBP from 8.6 to 23.8 mg/dl (P < 0.001). Changes in total 25(OH)D were positively and independently associated with changes in DBP (P < 0.05) and albumin (P < 0.001). Free 25(OH)D concentrations rose from 6.0 to 9.7 pg/ml (P < 0.001). In contrast, total 1,25(OH)(2)D concentrations rose only by 4.3 pg/ml (P < 0.001) and free 1,25(OH)(2D concentrations declined (P < 0.001).
  
  
  CONCLUSIONS
  Serum total and free 25(OH)D and DBP concentrations rose substantially following transplantation, while 1,25(OH)(2) D concentrations showed modest changes and free 1,25(OH)(2) D decreased. Studies of the effects of vitamin D status on diverse transplant complications are needed.
authors.affiliation: Renal Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6021, USA. peter.reese@uphs.upenn.edu
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Roy D
authors.initials: RD
authors.lastname: Bloom
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.forename: Ari
authors.initials: A
authors.lastname: Huverserian
authors.forename: Arwin
authors.initials: A
authors.lastname: Thomasson
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hamano
authors.forename: Simin
authors.initials: S
authors.lastname: Goral
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
authors.forename: Kimberly
authors.initials: K
authors.lastname: Olthoff
authors.forename: Michael R
authors.initials: MR
authors.lastname: Rickels
authors.forename: Melissa
authors.initials: M
authors.lastname: Bleicher
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
mesh_terms: D002112:Calcifediol / Q000097:blood; D002117:Calcitriol / Q000097:blood; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood; D014809:Vitamin D-Binding Protein / Q000097:blood*
chemical_list: D014809:Vitamin D-Binding Protein; D014807:Vitamin D; D002117:Calcitriol; D002112:Calcifediol
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