Introduction: Vitamin D deficiency in kidney transplant recipients (KTRs) is an emerging theme. The purported associations between Vitamin D deficiency and various metabolic, cardiovascular and non-metabolic adverse events have not been thoroughly studied in KTRs.

Methods: In this prospective observational study, we examined the association between Vitamin D deficiency, graft loss, mortality, NODAT, cardiovascular events and development of cancers.

Results: 504 KTRs had their vitamin D checked in 2008 and were followed up for 100 months. Vitamin D status was defined as normal (N, >50nmol/L), insufficiency (Ins, 25-50 nmol/L) or deficiency (Def, <25 nmol/L) as per WHO criteria. The prevalence of vitamin D deficiency was high at 66.5% with a significantly higher prevalence in older and female recipients, and in relatively new transplants. KTRs who were vitamin D deficient had significantly worse mortality (N, 4% vs. Ins, 9% vs. Def 14% p<0.001), death censored graft loss (N, 4% vs. Ins, 7% vs. Def 13%, P<0.001), development of NODAT (N, 8% vs. Ins, 15% vs. Def, 15% p=0.01) and cardiovascular events (N, 2% vs. Ins, 5% vs. Def, 9%, p=0.01) when compared to those with normal levels (N). Although vitamin D deficiency is not associated with a higher incidence of malignancy, it is associated with higher mortality in those with cancer (Def, 79% vs. N and Ins, 37%, p=0.01). In a multivariate Cox model, vitamin D deficiency was associated with significantly worse mortality (Ins, HR 2.3, p=0.004; Def, HR 3.3, p<0.001) and death censored graft loss (Ins, HR 2.0, p=0.03; Def. HR 3.1, p<0.001), NODAT (Ins, HR 2.0, p=0.02; Def, HR, 2.2. p=0.005) and cardiovascular events (Ins, HR 2.4 p=0.05; Def 3.3, p=0.008) independent of age, PTH levels, gender, graft number, type of transplant, time since transplantation, graft type and renal function, proteinuria, steroid usage and Calcium phosphate product.

Discussion: Vitamin D deficiency, which is highly prevalent in KTRs is associated with adverse clinical outcomes. Our study stresses the need for a prospective trial of vitamin D replacement in KTRs.

CITATION INFORMATION: Seitz A, Cherukuri A, Baker R. Beyond the Bones – The Association Between Vitamin D, Graft Outcomes, Malignancy and Vascular Disease. Am J Transplant. 2017;17 (suppl 3).

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