2017 - CIRTA


This page contains exclusive content for the member of the following sections: TTS, ITA. Log in to view.

10- Intestinal Transplantation

52.16 - Vitamin D deficiency is associated with an increased risk of post-transplant lymphoproliferative disorder following small intestinal and multivisceral transplantation.

Presenter: Jeremy, Woodward, Cambridge, United Kingdom
Authors: Adam McCulloch, Dunecan Massey, Lisa Sharkey, Stephen Middleton, Jackie Green, Neil Russell, Andrew Butler, Jeremy Woodward

Vitamin D deficiency is associated with an increased risk of post-transplant lymphoproliferative disorder following small intestinal and multivisceral transplantation.

Adam McCulloch1, Dunecan Massey1, Lisa Sharkey1, Stephen Middleton1, Jackie Green2, Neil Russell2, Andrew Butler2, Jeremy Woodward1.

1Gastroenterology, Cambridge University Hospital Trust, Cambridge, United Kingdom; 2Transplant Surgery, Cambridge University Hospital Trust, Cambridge, United Kingdom

Introduction: Vitamin D exerts a number of immunomodulatory effects. Studies have shown a link between vitamin D deficiency and incidence of acute rejection and infection in solid organ transplant recipients but none have examined small bowel and multivisceral transplantation. We hypothesised that vitamin D deficiency following small bowel or multivisceral transplant may increase the risk of acute rejection, cytomegalovirus (CMV) infection, sepsis or post-transplant lymphoproliferative disorder (PTLD).

Methods: This was a single centre retrospective review of patients who had received small intestinal or multivisceral transplants from January 2007 to August 2016. Opportunistically measured post-transplantation vitamin D levels were reviewed and compared with the onset of significant immunological events within 6 months of each measurement. The control vitamin D values included all transplant recipients’ vitamin D measures that did not correspond with an immunological event within 6 months.

Results: A total of 57 transplants (11 intestinal, 15 modified multivisceral, 31 multivisceral) in 54 patients were evaluated (females: 26, avg age at transplantation: 43.4 yrs, age range: 19 - 62). 8 patients were excluded due to insufficient data. Vitamin D deficiency (<30 nmol/L as defined by the Endocrine Society Clinical Practice 2011 guideline) was seen in 61.1% of patients post-transplantation. A total of 205 vitamin D levels were reviewed with 65.0% of vitamin D measurements not corresponding with an immunological event. Vitamin D deficiency was significantly associated with PTLD (OR 9.31, 95% CI 1.82 - 47.7, p value 0.005). The average length of time between the vitamin D level and PTLD diagnosis was 37 days (range 0 – 125). Average length of time from transplantation to PTLD diagnosis was 211.5 days (range: 76 – 566). Low vitamin D levels were also significantly associated with mild acute rejection (OR 3.6, 95% CI 1.4 – 9.1, p-value 0.008).

Conclusions: We have shown a strong association between vitamin D deficiency and PTLD following multivisceral and small intestinal transplantation. Vitamin D deficiency may increase susceptibility to Epstein-Barr virus infection leading to PTLD. Vitamin D deficiency had a significant association with mild rejection but not more advanced grades of rejection. This may be due a direct effect of vitamin D levels on intestinal apoptotic cell counts rather than a risk factor for rejection and may lead to overdiagnosis of mild rejection.


Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Social

Contact

Staff Directory
+1-514-874-1717
info@tts.org

Address

The Transplantation Society
International Headquarters
740 Notre-Dame Ouest
Suite 1245
Montréal, QC, H3C 3X6
Canada