Vitamin D and the risk of acute allograft rejection following human liver transplantation

Liver Int. 2010 Mar;30(3):417-44. doi: 10.1111/j.1478-3231.2009.02154.x. Epub 2009 Oct 22.


Background: Vitamin D may act as an immune modulator in experimental and human organ transplantation, but these data are yet to be confirmed in human liver transplantation (LT).

Aim: This study aimed to assess the relationship between acute liver allograft cellular rejection (ACR) and pretransplant serum vitamin D concentration or post-transplant vitamin D supplementation.

Method: We studied 133 LT recipients who underwent two per protocol allograft biopsies in the early post-operative period, plus on-demand biopsies as clinically indicated. ACR estimate was given according to the Banff scheme in biopsies obtained along two follow-up periods: (a) from the transplant operation to the end of the second month (0-2 months); (b) and from the third month to the end of the eighth month (3-8 months) post-LT.

Results: The median pretransplant serum 25-hydroxyvitamin D concentration was 12.5 ng/ml; 40 patients had concentrations < or =12.5 ng/ml, of whom six had < or =5.0 ng/ml. Seventy-nine recipients received oral vitamin D(3) supplementation to treat post-transplant osteoporosis. In the 0-2 months period, moderate-to-severe rejection episodes were independently associated with cytomegalovirus reactivation (P<0.005) and progressively lower pretransplant serum 25-hydroxyvitamin D concentrations (P<0.02). Early vitamin D(3) supplementation was independently associated with a lack of ACR (P<0.05).

Conclusions: These results suggest that vitamin D may favour immune tolerance towards the liver allograft.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Calcifediol / blood
  • Calcitriol / therapeutic use
  • Cholecalciferol / therapeutic use*
  • Female
  • Graft Rejection / pathology
  • Graft Rejection / prevention & control*
  • Humans
  • Liver / pathology
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Osteoporosis / drug therapy
  • Vitamins / therapeutic use
  • Young Adult


  • Vitamins
  • Cholecalciferol
  • Calcitriol
  • Calcifediol