title: EFFECTIVENESS AND OUTCOMES OF CURRENT PRACTICE IN TREATING VITAMIN D DEFICIENCY IN PATIENTS LISTED FOR LIVER TRANSPLANTATION.
abstract: OBJECTIVE
  Vitamin D deficiency is prevalent in cirrhotic patients awaiting liver transplantation (LT). Optimal vitamin D management for these patients remains undefined. We sought to determine the effectiveness of our practice in addressing vitamin D deficiency in LT patients.
  
  
  METHODS
  This retrospective study included 127 patients who received a first LT between July 2010 and July 2011. Outcomes measured included readmission rates, fractures, and functional status post-LT. 25-Hydroxyvitamin D (25-OH D) deficiency was stratified as: mild (20-30 ng/mL), moderate (15-19.9 ng/mL), and severe (<15 ng/mL). We estimated the amount of vitamin D supplementation required for each patient.
  
  
  RESULTS
  At LT evaluation, 107 patients (84%) had vitamin D deficiency, and 74% remained vitamin D deficient at LT. Only 62% received vitamin D supplementation pre-LT. Moderate and severe deficiencies were less common at LT and rare 4 months post-LT. There was an association between improvement in vitamin D deficiency category at LT and increased vitamin D (>400,000 IU total) supplementation (P = .004). We found no association between vitamin D deficiency at LT and functional status, fractures, or readmissions post-LT. Patients receiving induction immunosuppressant therapy with basiliximab had a significantly greater degree of worsening in bone mineral density (BMD) post-LT.
  
  
  CONCLUSIONS
  Moderate-to-severe vitamin D deficiency was very prevalent in a cohort of patients undergoing evaluation for LT. Deficiency was improved with increased vitamin D replacement therapy. Vitamin D deficiency at LT was not associated with worse bone or functional outcomes post-LT. The influence of basiliximab on bone health post-LT requires further evaluation.
authors: Amanda
authors: A
authors: Chaney
authors: Michael G
authors: MG
authors: Heckman
authors: Nancy N
authors: NN
authors: Diehl
authors: Shon
authors: S
authors: Meek
authors: Andrew P
authors: AP
authors: Keaveny
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000077552:Basiliximab; D015519:Bone Density / Q000187:drug effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011993:Recombinant Fusion Proteins / Q000009:adverse effects*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014807:Vitamin D / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D014808:Vitamin D Deficiency / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D014807:Vitamin D; D000077552:Basiliximab; C104450:25-hydroxyvitamin D