title: Low vitamin D levels are associated with increased rejection and infections after lung transplantation.
abstract: BACKGROUND
  The prevalence of vitamin D deficiency in lung disease is greater than in the general population. Vitamin D deficiency may negatively affect immune and lung function. Accordingly, we hypothesized that lung transplant recipients with vitamin D deficiency are more susceptible to rejection and infections after transplantation.
  
  
  METHODS
  Transplant outcomes were reviewed in a retrospective cohort of 102 lung transplant recipients who had 25-hydroxyvitamin D [25(OH)D] levels drawn during the near-transplant period (100 days pre- or post-transplant).
  
  
  RESULTS
  In the near-transplant period, 80% of recipients were 25(OH)D-deficient and 20% were not 25(OH)D-deficient. Episodes of acute cellular rejection in the deficient group were more frequent than in the non-deficient group [mean 1.27 (0.99 to 1.55) vs 0.52 (0.12 to 0.93), p = 0.006]. The rejection rate in the deficient group was more than double that of the the non-deficient group [IRR 2.43 (1.30 to 4.52), p = 0.005]. Infectious episodes were also more frequent in the deficient group than in the non-deficient group [mean 4.01 (3.24 to 4.79) vs 2.71 (1.47 to 3.96), p = 0.04]. The mortality rate of recipients who remained 25(OH)D-deficient 1 year after transplant was almost 5-fold higher than in recipients who were not 25(OH)D-deficient [IRR 4.79 (1.06 to 21.63), p = 0.04].
  
  
  CONCLUSIONS
  Low serum 25(OH)D levels in lung transplant recipients were associated with increased incidence of acute rejection and infection. The mortality of recipients who remained deficient 1 year post-transplant was higher than that of recipients who maintained normal vitamin D levels at 1 year post-transplant.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA. elowery@lumc.edu
authors.forename: Erin M
authors.initials: EM
authors.lastname: Lowery
authors.forename: Bradford
authors.initials: B
authors.lastname: Bemiss
authors.forename: Thomas
authors.initials: T
authors.lastname: Cascino
authors.forename: Ramon A
authors.initials: RA
authors.lastname: Durazo-Arvizu
authors.forename: Sean M
authors.initials: SM
authors.lastname: Forsythe
authors.forename: Charles
authors.initials: C
authors.lastname: Alex
authors.forename: Franco
authors.initials: F
authors.lastname: Laghi
authors.forename: Robert B
authors.initials: RB
authors.lastname: Love
authors.forename: Pauline
authors.initials: P
authors.lastname: Camacho
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D014807:Vitamin D