The Association of 25-Hydroxyvitamin D Levels with Late Cytomegalovirus Infection in Kidney Transplant Recipients: the Wisconsin Allograft Recipient Database

Brad C. Astor, Arjang Djamali, Didier A. Mandelbrot, Sandesh Parajuli, Michal L. Melamed

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in kidney transplant recipients. Vitamin D has an integral role in proper immune function, and deficiency is common among kidney transplant recipients. It remains unclear whether 25-hydroxyvitamin D [25(OH)D] level is associated with CMV infection in kidney transplant recipients. METHODS: We examined the relationship between 25(OH)D levels, measured at least 6 months posttransplant, and subsequent CMV infection in 1976 recipients free of prior CMV infection. RESULTS: Of 1976 recipients, 251 (12.7%) were vitamin D deficient [25(OH)D <20 ng/mL] and 548 (27.7%) were insufficient (20-29 ng/mL) at the time of the first 25(OH)D measurement. A total of 107 recipients had a CMV infection within 1 year of a 25(OH)D measurement. Vitamin D deficiency was associated with a 1.81-fold higher risk (relative hazard = 1.81; 95% confidence interval [CI], 1.06-3.09) than vitamin D sufficiency after adjustment for baseline characteristics and concurrent graft function and blood calcineurin inhibitor concentration. Each 1 ng/mL lower 25(OH)D was associated with a 2% higher risk of infection (95% CI, 0%-4%) in continuous analyses after adjustment. CONCLUSIONS: Low 25(OH)D is common in kidney transplant recipients and associated with late CMV infection. These results highlight the need for interventional trials to assess the potential for vitamin D supplementation to reduce infectious complications in kidney transplant recipients.

Original languageEnglish (US)
Pages (from-to)1683-1688
Number of pages6
JournalTransplantation
Volume103
Issue number8
DOIs
StatePublished - Aug 1 2019

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Cytomegalovirus Infections
Allografts
Databases
Kidney
Vitamin D
Confidence Intervals
Vitamin D Deficiency
25-hydroxyvitamin D
Transplant Recipients
Morbidity
Transplants
Mortality
Infection

ASJC Scopus subject areas

  • Transplantation

Cite this

The Association of 25-Hydroxyvitamin D Levels with Late Cytomegalovirus Infection in Kidney Transplant Recipients : the Wisconsin Allograft Recipient Database. / Astor, Brad C.; Djamali, Arjang; Mandelbrot, Didier A.; Parajuli, Sandesh; Melamed, Michal L.

In: Transplantation, Vol. 103, No. 8, 01.08.2019, p. 1683-1688.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in kidney transplant recipients. Vitamin D has an integral role in proper immune function, and deficiency is common among kidney transplant recipients. It remains unclear whether 25-hydroxyvitamin D [25(OH)D] level is associated with CMV infection in kidney transplant recipients. METHODS: We examined the relationship between 25(OH)D levels, measured at least 6 months posttransplant, and subsequent CMV infection in 1976 recipients free of prior CMV infection. RESULTS: Of 1976 recipients, 251 (12.7{\%}) were vitamin D deficient [25(OH)D <20 ng/mL] and 548 (27.7{\%}) were insufficient (20-29 ng/mL) at the time of the first 25(OH)D measurement. A total of 107 recipients had a CMV infection within 1 year of a 25(OH)D measurement. Vitamin D deficiency was associated with a 1.81-fold higher risk (relative hazard = 1.81; 95{\%} confidence interval [CI], 1.06-3.09) than vitamin D sufficiency after adjustment for baseline characteristics and concurrent graft function and blood calcineurin inhibitor concentration. Each 1 ng/mL lower 25(OH)D was associated with a 2{\%} higher risk of infection (95{\%} CI, 0{\%}-4{\%}) in continuous analyses after adjustment. CONCLUSIONS: Low 25(OH)D is common in kidney transplant recipients and associated with late CMV infection. These results highlight the need for interventional trials to assess the potential for vitamin D supplementation to reduce infectious complications in kidney transplant recipients.",
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