Nutrition Support in Liver Transplantation and Postoperative Recovery: The Effects of Vitamin D Level and Vitamin D Supplementation in Liver Transplantation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Post-Transplant Management
2.3. Vitamin D Measurement
2.4. Statistical Analysis
3. Results
3.1. Demographical Characteristics of Patients
3.2. Influence of Preoperative and Postoperative Serum Vitamin D Levels on Overall Survival
3.3. Influence of Preoperative and Postoperative Serum Vitamin D Levels on Acute Cellular Rejection
3.4. Comparison of Patient Characteristics Based on Vitamin D Supplementation Status
3.5. Effect of Vitamin D Supplementation on Overall Survival
3.6. Effect of Vitamin D Supplementation on Acute Cellular Rejection
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Recipient Characteristics | |
Age, years, Median (IQR) | 58 (52–64) |
Sex, male, Number (%) | 350 (66.2) |
Height, cm, Median (IQR) | 174.0 (165.8–180.3) |
Weight, kg, Median (IQR) | 86.2 (72.3–101.3) |
Body mass index, kg/m2, Median (IQR) | 28.7 (24.8–33.8) |
Cause of cirrhosis, Number (%) | |
Viral hepatitis | 103 (19.5) |
PBC/PSC/AIH | 85 (16.1) |
NASH/Cryptogenic | 136 (25.9) |
Alcohol | 154 (29.1) |
Other | 50 (9.5) |
Exception for HCC, Number (%) | 202 (17.7) |
Medical condition at the time of LT, Number (%) | |
ICU | 39 (7.4) |
Hospitalized | 207 (39.5) |
Home | 280 (53.1) |
Previous abdominal surgery, Number (%) | 266 (50.3) |
Portal vein thrombosis, Number (%) | 104 (19.7) |
MELD-Na score, Median (IQR) | 19 (13–28) |
Waiting time, months, Median (IQR) | 2.9 (0.8–7.4) |
Donor Characteristics | |
Age, years, Median (IQR) | 42 (30–54) |
Sex, male, Number (%) | 317 (59.9) |
Height, cm, Median (IQR) | 173.0 (165.0–180.0) |
Weight, kg, Median (IQR) | 82.1 (69.9–99.4) |
Body mass index, kg/m2, Median (IQR) | 28.1 (23.68–32.9) |
Graft type, Number (%) | |
DBD | 429 (81.3) |
DCD | 65 (12.3) |
Split | 34 (6.4) |
Race/Ethnicity, Number (%) | |
White | 410 (77.7) |
African American | 93 (17.6) |
Others | 25 (4.7) |
Cause of death, Number (%) | |
Head trauma | 251 (47.6) |
Anoxia | 150 (28.4) |
CVD | 120 (22.7) |
Others | 7 (1.3) |
Share type, Number (%) | |
Local | 300 (56.9) |
Regional | 180 (34.0) |
National | 48 (9.1) |
Cold ischemic time, hours, Median (IQR) | 6.2 (5.3–7.4) |
All Patients | |||
---|---|---|---|
Deficient (20 ng/mL<) | Sufficient (≥20 ng/mL) | p Value | |
Characteristics | |||
Age >60 years, Number (%) | 93 (37.1) | 108 (51.7) | <0.01 |
Sex, Number (%) | 0.37 | ||
Male | 173 (68.9) | 135 (64.6) | |
Female | 78 (31.1) | 74 (35.4) | |
Body mass index, kg/m2, Median (IQR) | 28.7 (24.7–34.1) | 28.6 (25.0–33.3) | 0.90 |
Main liver disease, Number (%) | 0.08 | ||
HBV/HCV | 37 (14.7) | 49 (23.4) | |
PBC/PSC/AIH | 40 (15.9) | 34 (16.3) | |
NASH | 68 (27.1) | 54 (25.8) | |
Alcohol | 83 (33.1) | 50 (23.9) | |
Other | 23 (9.2) | 22 (10.5) | |
Hepatocellular carcinoma, Number (%) | 64 (25.5) | 77 (36.8) | 0.01 |
Diabetes mellitus, Number (%) | 70 (27.9) | 66 (31.6) | 0.41 |
Alcohol consumption, Number (%) | 83 (33.1) | 50 (23.9) | 0.04 |
MELD-Na score, Median (IQR) | 22 (16–29) | 16 (10–24) | <0.01 |
Albumin, g/dL, Median (IQR) | 3.0 (2.6–3.5) | 3.2 (2.8–3.7) | 0.04 |
25(OH)D, Pre-transplant, ng/mL, Median (IQR) | 12.9 (9.1–16.5) | 27.0 (23.1–32.9) | <0.01 |
25(OH)D, Post-transplant, ng/mL, Median (IQR) | 22.1 (14.4–29.0) | 27.1 (20.3–35.5) | 0.32 |
Crossmatch for T and B cell, Number (%) | 0.24 | ||
T cell: −/B cell: − | 154 (61.4) | 129 (61.7) | |
T cell: +/B cell: − | 16 (6.4) | 9 (4.3) | |
T cell: −/B cell: + | 47 (18.7) | 51 (24.4) | |
T cell: +/B cell: + | 34 (13.5) | 20 (9.6) |
Bivariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Variable | HR (95% CI) | p-Value | HR (95% CI) | p Value |
Age >60 years | 2.84 (1.60–5.05) | <0.01 | 3.47 (1.38–8.68) | <0.01 |
Sex (Male) | 0.79 (0.46–1.36) | 0.39 | 0.65 (0.28–1.54) | 0.33 |
Body mass index | 0.87 (0.50–1.50) | 0.61 | ||
MELD-Na score >30 | 1.70 (0.94–3.04) | 0.08 | 1.02 (0.97–1.06) | 0.47 |
Hepatocellular carcinoma | 1.48 (0.85–2.55) | 0.16 | ||
Alcohol-related cirrhosis | 0.75 (0.47–1.19) | 0.22 | ||
Vitamin D sufficiency, Pre-transplant | 1.15 (0.65–2.03) | 0.63 | 1.02 (0.42–2.44) | 0.97 |
Vitamin D sufficiency, Post-transplant | 0.44 (0.21–0.96) | 0.04 | 0.31 (0.13–0.75) | <0.01 |
Vitamin D supplementation, Pre-transplant | 1.28 (0.71–2.32) | 0.41 | ||
Vitamin D supplementation, Post-transplant | 0.92 (0.53–1.61) | 0.78 | ||
Crossmatch for T or B cell positive | 1.26 (0.85–1.87) | 0.26 |
All Patients (N = 528) | |||||
---|---|---|---|---|---|
Characteristics | No Supplementation N = 131 | Pre N = 47 | Post N = 41 | Pre/Post N = 309 | p Value |
Age >60 years, Number (%) | 65 (49.6) | 18 (38.3) | 14 (34.1) | 138 (44.7) | 0.27 |
Sex, Number (%) | 0.03 | ||||
Male | 98 (74.8) | 29 (61.7) | 31 (75.6) | 191 (61.8) | |
Female | 33 (25.2) | 18 (38.3) | 10 (24.4) | 118 (38.2) | |
Body mass index, kg/m2, Median (IQR) | 28.7 (24.7–33.8) | 28.5 (22.7–33.1) | 29.0 (25.5–33.3) | 28.7 (24.9–34.0) | 0.98 |
Main liver disease, Number (%) | 0.12 | ||||
HBV/HCV | 35 (26.7) | 11 (23.4) | 5 (12.2) | 52 (16.8) | |
PBC/PSC/AIH | 15 (11.5) | 8 (17.0) | 3 (7.3) | 59 (19.1) | |
NASH | 32 (24.4) | 11 (23.4) | 14 (34.1) | 80 (25.9) | |
Alcohol | 38 (29.0) | 14 (29.8) | 11 (26.8) | 90 (29.1) | |
Other | 11 (8.4) | 3 (6.4) | 8 (19.5) | 28 (9.1) | |
Hepatocellular carcinoma, Number (%) | 44 (33.6) | 15 (31.9) | 11 (26.8) | 88 (28.5) | 0.70 |
Diabetes mellitus, Number (%) | 40 (30.5) | 17 (36.2) | 9 (22.0) | 87 (28.2) | 0.49 |
Alcohol consumption, Number (%) | 38 (29.0) | 14 (29.8) | 11 (26.8) | 90 (29.1) | 0.99 |
MELD-Na score, Median (IQR) | 19 (13–28) | 18 (11–27) | 22 (15–28) | 19 (14–28) | 0.82 |
Albumin, g/dL, Median (IQR) | 3.0 (2.6–3.5) | 3.1 (2.8–3.5) | 3.10 (2.4–3.8) | 3.2 (2.7–3.6) | 0.88 |
25(OH)D, Pre-transplant, ng/mL, Median (IQR) | 18.1 (11.9–24.4) | 14.3 (9.2–22.6) | 17.65 (10.5–21.5) | 20.2 (13.8–28.4) | <0.01 |
25(OH)D, Post-transplant, ng/mL, Median (IQR) | 23.6 (19.4–33.6) | 23.2 (13.1–29.3) | 18.9 (11.4–23.9) | 25.5 (18.2–34.1) | 0.36 |
Crossmatch for T and B cell, Number (%) | 0.12 | ||||
T cell: −/B cell: − | 83 (63.4) | 26 (55.3) | 32 (78.0) | 180 (58.3) | |
T cell: +/B cell: − | 7 (5.3) | 2 (4.3) | 2 (4.9) | 19 (6.1) | |
T cell: −/B cell: + | 30 (22.9) | 15 (31.9) | 7 (17.1) | 66 (21.4) | |
T cell: +/B cell: + | 11 (8.4) | 4 (8.5) | 0 (0.0) | 44 (14.2) |
Bivariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Variables | sHR (95% CI) | p Value | sHR (95% CI) | p Value |
Age >60 years | 1.03 (0.42–2.53) | 0.95 | 0.30 (0.12–0.77) | 0.01 |
Sex (Male) | 1.02 (0.50–2.08) | 0.95 | ||
Calculated MELD-Na >30 | 0.34 (0.08–1.43) | 0.14 | 0.28 (0.07–1.17) | 0.08 |
Hepatocellular carcinoma | 0.95 (0.47–1.94) | 0.89 | ||
Alcohol-related cirrhosis | 1.00 (0.48–2.06) | 0.99 | ||
Vitamin D supplementation, Pre-transplant | 1.39 (0.67–2.87) | 0.38 | 1.05 (0.43–2.57) | 0.92 |
Vitamin D sufficiency, Pre-transplant | 1.23 (0.59–2.59) | 0.58 | 1.38 (0.63–3.01) | 0.42 |
Crossmatch for T or B cell positive | 0.94 (0.48–1.86) | 0.86 |
Bivariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Variables | sHR (95% CI) | p Value | sHR (95% CI) | p Value |
Age >60 years | 0.42 (0.17–1.06) | 0.07 | 0.38 (0.07–2.02) | 0.26 |
Sex (Male) | 0.91 (0.36–2.27) | 0.84 | ||
Calculated MELD-Na > 30 | 0.34 (0.08–1.43) | 0.14 | <0.01 (<0.01–<0.01) | <0.01 |
Hepatocellular carcinoma | 1.24 (0.52–2.93) | 0.63 | ||
Alcohol-related cirrhosis | 1.44 (0.61–3.40) | 0.40 | ||
Vitamin D supplementation, Post-transplant | 0.14 (0.02–1.07) | 0.06 | 0.09 (0.01–0.72) | 0.02 |
Vitamin D sufficiency, Post-transplant | 0.85 (0.18–4.04) | 0.84 | 0.69 (0.14–3.48) | 0.65 |
Crossmatch for T or B cell positive | 1.71 (0.74–3.91) | 0.21 |
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Doi, J.; Moro, A.; Fujiki, M.; Eghtesad, B.; Quintini, C.; Menon, K.V.N.; Hashimoto, K.; Sasaki, K. Nutrition Support in Liver Transplantation and Postoperative Recovery: The Effects of Vitamin D Level and Vitamin D Supplementation in Liver Transplantation. Nutrients 2020, 12, 3677. https://doi.org/10.3390/nu12123677
Doi J, Moro A, Fujiki M, Eghtesad B, Quintini C, Menon KVN, Hashimoto K, Sasaki K. Nutrition Support in Liver Transplantation and Postoperative Recovery: The Effects of Vitamin D Level and Vitamin D Supplementation in Liver Transplantation. Nutrients. 2020; 12(12):3677. https://doi.org/10.3390/nu12123677
Chicago/Turabian StyleDoi, Junshi, Amika Moro, Masato Fujiki, Bijan Eghtesad, Cristiano Quintini, K. V. Narayanan Menon, Koji Hashimoto, and Kazunari Sasaki. 2020. "Nutrition Support in Liver Transplantation and Postoperative Recovery: The Effects of Vitamin D Level and Vitamin D Supplementation in Liver Transplantation" Nutrients 12, no. 12: 3677. https://doi.org/10.3390/nu12123677