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Abstract: SA-PO1084

The Association Between 25-Hydroxyvitamin D and Recurrence of Glomerulonephritis in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Yuan, Zhongyu, University of Wisconsin-Madison Department of Population Health Sciences, Madison, Wisconsin, United States
  • Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
  • Singh, Tripti, University of Wisconsin-Madison Department of Medicine, Madison, Wisconsin, United States
  • Parajuli, Sandesh, University of Wisconsin-Madison Department of Medicine, Madison, Wisconsin, United States
  • Panzer, Sarah E., University of Wisconsin-Madison Department of Medicine, Madison, Wisconsin, United States
  • Mandelbrot, Didier A., University of Wisconsin-Madison Department of Medicine, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison Department of Population Health Sciences, Madison, Wisconsin, United States
Background

Disease recurrence contributes significantly to allograft failure in kidney transplant recipients (KTR) with kidney failure due to glomerulonephritis (GN). Accumulating evidence has revealed a role of vitamin D in innate and adaptive immunity. While vitamin D deficiency is common among KTRs, the association between 25-hydroxyvitamin D [25(OH)D] and GN recurrence in KTRs remains unclear.

Methods

Data from KTRs with GN (focal segmental glomerulosclerosis, IgA nephropathy, membranous nephropathy, membranoproliferative GN, or lupus nephritis) transplanted at our center from 2000-2019 were analyzed. All post-transplant serum 25(OH)D measurements were included as a time-varying covariate. Disease recurrence was identified via allograft biopsy following abnormal clinical signs or laboratory measures. Survival models considered other causes of allograft loss, including death, as competing risk events. Disease recurrence within one year after each 25(OH)D measurement was considered as the event of interest. Models were adjusted for age at transplant, sex, race, donor status, prior transplant, and time of 25(OH)D measurement.

Results

A total of 63 cases of GN recurrence (median: 4.6 years) were identified in 823 KTRs followed for a median of 7.6 years after transplant. Each 1 ng/ml lower serum 25(OH)D was associated with a 5% higher incidence of recurrence (adjusted hazard ratio [aHR] = 1.05; 95% CI, 1.02-1.07). Vitamin D deficiency (≤ 20 ng/ml) was associated with a 3.04-fold (aHR = 3.04; 95% CI, 1.60-5.78) higher incidence of recurrence compared with vitamin D sufficiency (≥ 30 ng/ml). Similar results were found after further adjusting for concurrent urinary protein:creatinine ratio and excluding events within 30 days after 25(OH)D measurement (Table).

Conclusion

Vitamin D deficiency is associated with a higher incidence of GN recurrence in KTRs independently of proteinuria. Additional research is needed to explore the utility of vitamin D surveillance and management in KTRs with GN.

Table. Association between serum 25(OH)D and GN recurrence.