Introduction:

In addition to its cardinal role in bone-mineral metabolism, the hormone vitamin D is reported to regulate multiple aspects of the immune repertoire. In this study, we investigated the hypothesis that 25-hydroxyvitamin D deficiency is associated with biopsy confirmed acute cellular rejection (ACR) in kidney allograft recipients.

Methods:

We identified 375 renal transplant recipients who had 25-hydroxyvitamin D (25-Vit D) measured within the first month of transplantation. We utilized a multivariable Cox regression to determine whether 25-Vit D deficiency, defined as ≤ 20 ng/mL, is associated with ACR within the first year of transplantation. We also evaluated the pretransplant risk factors for 25-Vit D deficiency.

Results:

25-Vit D deficiency was common and present in 61% of the renal transplant recipients; in our cohort, ACR developed in 7.7% within the first year of transplantation. Time to event Kaplan Meier survival analysis showed ACR free survival was lower in the 25-Vit D deficiency group than in the 25-Vit D replete group (Log rank test:P=0.03).

In a multivariable cox regression analysis, 25-Vit D deficiency was independently associated with ACR (HR:2.94,P=0.02), and was a stronger risk factor compared to traditional factors such as deceased donor transplantation or DGF.

We also determined the following pretransplant risk factors for 25-Vit D: African American race (OR:3.54,P<0.001), female gender (OR:2.16,P=0.001), and diabetes mellitus (OR:1.90,P=0.01) (multivariable logistic regression).

Conclusion:

We have identified 25-Vit D deficiency as an independent risk factor for the development of ACR. African American race, female gender, and diabetes mellitus are risk factors for 25-Vit D deficiency within the first month of transplantation.

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