title: 1,25 Dihydroxyvitamin D circulating levels, calcitriol administration, and incidence of acute rejection, CMV infection, and polyoma virus infection in renal transplant recipients.
abstract: Observation that 1,25-Dihydroxyvitamin-D3 has an immunomodulatory effect on innate and adaptive immunity raises the possible effect on clinical graft outcome. Aim of this study was to evaluate the correlation of biopsy-proven acute rejection, CMV infection, BKV infection, with 1,25-Dihydroxyvitamin-D3 deficiency and the benefit of calcitriol supplementation before and during the transplantation. Risk factors and kidney graft function were also evaluated. All RTRs received induction therapy with basiliximab, cyclosporine, mycophenolic acid, and steroids. During the first year, the incidence of BPAR (4% vs 11%, P=.04), CMV infection (3% vs 9%, P=.04), and BKV infection (6% vs 19%, P=.04) was significantly lower in users compared to controls. By multivariate Cox regression analysis, 1,25-Dihydroxyvitamin-D3 deficiency and no calcitriol exposure were independent risk factors for BPAR (HR=4.30, P<.005 and HR=3.25, P<.05), for CMV infection (HR=2.33, P<.05 and HR=2.31, P=.001), and for BKV infection (HR=2.41, P<.05 and HR=2.45, P=.001). After one year, users had a better renal function: eGFR was 62.5±6.7 mL/min vs 51.4±7.6 mL/min (P<.05). Only one user developed polyomavirus-associated nephropathy vs 15 controls. Two users lost their graft vs 11 controls. 1,25(OH)2-D3 deficiency circulating levels increased the risk of BPAR, CMV infection, BKV infection after kidney transplantation. Administration of calcitriol is a way to obtain adequate 1,25(OH)2-D3 circulating levels.
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy. moscarellil@libero.it.
authors.forename: Luciano
authors.initials: L
authors.lastname: Moscarelli
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Antognoli
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Buti
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Egrina
authors.initials: E
authors.lastname: Dervishi
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Fani
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Caroti
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Aris
authors.initials: A
authors.lastname: Tsalouchos
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Romoli
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Ghiandai
authors.affiliation: Renal Unit, Careggi University Hospital, Florence, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Minetti
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002117:Calcitriol / Q000097:blood / Q000172:deficiency* / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D014815:Vitamins; D002117:Calcitriol
keywords: 1,25(OH)2-D3; acute rejection; associated nephropathy; cytomegalovirus disease; polyomavirus; renal transplant