*Purpose: Patients with chronic liver disease are at risk of nutritional deficiency. The goal of this study was to determine the prevalence of vitamin D deficiency in Liver Transplant (LTx) recipients and study the effects of a vitamin D supplementation protocol after LTx.

*Methods: Retrospective analysis of adult LTx performed at our institution between 7/1/2019 to 3/1/2021. Pre-LTx and post-LTx data was collected including details on vitamin D supplementation, and both pre and post LTx vitamin D related complications. A vitamin D supplementation protocol based on pre-transplant Vitamin D levels with patients receiving either high dose (50,000 U weekly) or low dose (1000U daily) was implemented. Statistical analysis was performed.

*Results: 255 LTx recipients were included in the study. Pre LTx vitamin D deficiency was noted in 196 (79.7%) of LTx recipients. 18.1% patients had osteoporosis pre-LTx. With both either high dose or low dose vitamin D, there was a significant increase in Vitamin D levels (mean change 21.9 ng/mL) compared to pre-LTx. This also resulted in decreased rates of osteoporosis in patients who received vitamin D supplementation. No differences were noted in other post LTx outcomes including survival, rejection in patients receiving vitamin D supplementation.

*Conclusions: Vitamin D deficiency is highly prevalent in LTx recipients. Routine screening pre-LTx and post transplant vitamin D supplementation should be part of care of LTx recipients.

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