Vitamin D in renal transplantation - from biological mechanisms to clinical benefits.
Recent developments in our understanding of vitamin D show that it plays a significant role in immunological health, uniquely occupying both an anti-microbial and immunoregulatory niche. Vitamin D deficiency is widespread amongst renal transplant recipients (RTRs), thus providing one patho-mechanism that may influence the achievement of a successful degree of immunosuppression. It may also influence the development of the infectious, cardiovascular and neoplastic complications seen in RTRs. This review examines the biological roles of vitamin D in the immune system of relevance to renal transplantation (RTx) and evaluates whether vitamin D repletion may be relevant in determining immunologically-related clinical outcomes in RTRs, (including graft survival, cardiovascular disease and cancer). While there are plausible biological and epidemiological reasons to undertake vitamin D repletion in RTRs, there are few randomized-controlled trials in this area. Based on the available literature, we cannot at present categorically make the case for routine measurement and repletion of vitamin D in clinical practice but we do suggest that this is an area in urgent need of further randomized controlled level evidence.
Medical Research Council Centre for Transplantation, King's College London; National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London.
R
R
McGregor
G
G
Li
H
H
Penny
G
G
Lombardi
B
B
Afzali
D J
DJ
Goldsmith
D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D014807:Vitamin D / Q000502:physiology*; D014808:Vitamin D Deficiency / Q000503:physiopathology*
D014807:Vitamin D
cancer; cardiovascular disease; immune system; renal transplantation; transplant rejection; vitamin D