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If you are getting a lung transplant you must have vitamin D - April 2012

Press Release April 2012

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Summary: Lung transplant poor if vitamin D deficient

2.4X more likely to reject the transplant
1.5X more likely to have infection
4.8X more likely to die within one year
    does not seem to state how much vitamin D was given

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VITAMIN D DEFICIENCY SHOWN TO INCREASE REJECTION RATES IN LUNG TRANSPLANT PATIENTS

MAYWOOD, Ill. — Vitamin D deficiency is associated with an increase in lung transplant rejection and infections, according to research conducted at Loyola University Health System (LUHS). Researchers also found that recipients who remained deficient for one year following the transplant had a higher mortality rate than those who had normal vitamin D levels. These data were published in the latest issue of The Journal of Heart and Lung Transplantation.

“Patients who undergo lung transplants are at risk for rejecting the organ, and two-thirds of these patients are vitamin D deficient,” said Erin Lowery, MD, first author, assistant professor, Department of Pulmonary and Critical Care Medicine, Loyola University Chicago Stritch School of Medicine (SSOM). “Given the high prevalence of vitamin D deficiency in lung transplant patients and the growing evidence that this supplement helps the immune system tolerate the organ, optimal levels of vitamin D are critical for positive outcomes in these patients."

The study evaluated 102 patients who underwent a lung transplant and had vitamin D levels evaluated within 100 days prior to or following surgery.

  • Twenty-one patients had normal vitamin D levels and
  • 81 were deficient.

The rejection rate in the deficient group was more than double that of the nondeficient group.
Infections also were more frequent in the deficient group than in the nondeficient group (mean 4.01 versus 2.71).
In addition, the mortality rate of vitamin D deficient patients one year after transplant was nearly five times higher than those who were not deficient.

Prior to lung transplant, 52 percent of patients received a vitamin D supplement.
An additional evaluation was performed one year after transplant to determine if levels were normal or deficient.
Seventy-five patients had normal vitamin D levels and 27 were deficient.
In the year after the lung transplant, all patients received a vitamin D supplement.

The health benefits of vitamin D are widespread and range from warding off cancer, osteoporosis, heart disease, diabetes and depression.
Until now, researchers could only speculate that vitamin D also improves the health of lung transplant patients.

“This was the first study to explore the impact of vitamin D deficiency in lung transplant patients,” said Pauline Camacho, MD, director of the Loyola University Osteoporosis and Metabolic Bone Disease Center, Loyola University Health System (LUHS). “We have determined that there are multiple benefits to maintaining normal vitamin D levels in lung transplant patients."

Other investigators were: Bradford Bemiss, MD, chief resident, Department of Medicine, SSOM; Thomas Cascino, fourth-year medical student, SSOM; Ramon Durazo-Arvizu, PhD, assistant professor, Department of Preventive Medicine & Epidemiology, SSOM; Sean M. Forsythe, MD, associate professor of medicine, Department of Pulmonary & Critical Care Medicine, SSOM; Charles Alex, MD, FCCP, program director for lung transplant, LUHS; Franco Laghi, MD, professor of medicine, Department of Pulmonary & Critical Care Medicine; and Robert B. Love, MD, lung transplant surgeon and professor, Departments of Thoracic & Cardiovascular Surgery and Microbiology & Immunology, SSOM.

The published paper

Low vitamin D levels are associated with increased rejection and infections after lung transplantation
Erin M. Lowery, MD, elowery at lumc.edu Bradford Bemiss, MD, Thomas Cascino, BS, Ramon A. Durazo-Arvizu, PhD, Sean M. Forsythe, MD, Charles Alex, MD, Franco Laghi, MD, Robert B. Love, MD, Pauline Camacho, MD
published online 05 March 2012.

Background
The prevalence of vitamin D deficiency in lung disease is greater than in the general population. Vitamin D deficiency may negatively affect immune and lung function. Accordingly, we hypothesized that lung transplant recipients with vitamin D deficiency are more susceptible to rejection and infections after transplantation.

Methods
Transplant outcomes were reviewed in a retrospective cohort of 102 lung transplant recipients who had 25-hydroxyvitamin D [25(OH)D] levels drawn during the near-transplant period (100 days pre- or post-transplant).

Results
In the near-transplant period, 80% of recipients were 25(OH)D-deficient and 20% were not 25(OH)D-deficient.
Episodes of acute cellular rejection in the deficient group were more frequent than in the non-deficient group [mean 1.27 (0.99 to 1.55) vs 0.52 (0.12 to 0.93), p = 0.006].
The rejection rate in the deficient group was more than double that of the the non-deficient group [IRR 2.43 (1.30 to 4.52), p = 0.005].
Infectious episodes were also more frequent in the deficient group than in the non-deficient group [mean 4.01 (3.24 to 4.79) vs 2.71 (1.47 to 3.96), p = 0.04].
The mortality rate of recipients who remained 25(OH)D-deficient 1 year after transplant
  was almost 5-fold higher than in recipients who were not 25(OH)D-deficient [IRR 4.79 (1.06 to 21.63), p = 0.04].

Conclusions
Low serum 25(OH)D levels in lung transplant recipients were associated with increased incidence of acute rejection and infection.
The mortality of recipients who remained deficient 1 year post-transplant was higher than that of recipients who maintained normal vitamin D levels at 1 year post-transplant.

Figure 3b from the internet

Vertical axis = # of people still alive

Both lines represent lung transplant: upper had good level of vitamin D, lower did not respond to amount of vitamin D given

Image
Comparison of those with normal 25(OH)D in the first year after transplant to those who remained persistently 25(OH)D-deficient.


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