Zhongyu Yuan, Sandesh Parajuli, Didier Mandelbrot, Michal L Melamed, Brad C Astor
{"title":"肾移植受者移植后循环25-羟基维生素D与长期患者和移植结果的关系:威斯康星同种异体移植受者数据库(WisARD)。","authors":"Zhongyu Yuan, Sandesh Parajuli, Didier Mandelbrot, Michal L Melamed, Brad C Astor","doi":"10.34067/KID.0000000942","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Vitamin D inadequacy at or shortly after kidney transplantation is associated with poor outcomes. Circulating 25-hydroxyvitamin D [25(OH)D] levels generally increase over time after transplantation, but inadequacy remains common. Few studies have examined associations of later circulating 25(OH)D levels and long-term outcomes.</p><p><strong>Methods: </strong>We analyzed data from the Wisconsin Allograft Recipient Database to assess the association of post-transplant 25(OH)D with overall graft failure, death-censored graft failure (DCGF), death with a functioning graft (DWFG), cause-specific mortality and eGFR trajectory over the next 4 years.</p><p><strong>Results: </strong>A total of 2504 recipients who maintained a functioning graft for at least 13 months were included in our analysis. A total of 867 overall graft failures occurred during a median follow-up of 6.8 years. Vitamin D deficiency (≤20 ng/ml) was associated with a 43% higher hazard of overall graft failure (95% confidence interval [CI]: 1.16, 1.78), a 2.24-fold higher hazard of DCGF (95% CI: 1.60, 3.12) and a 2.10-fold higher hazard (95% CI: 1.37, 3.21) of infection-related mortality compared with sufficiency. It also was associated with a 1.38 ml/min/1.73m2/year faster (95% CI: -1.97, -0.79) annual eGFR decline compared with sufficiency. No association was detected for DWFG or other cause-specific mortality.</p><p><strong>Conclusions: </strong>In conclusion, post-transplant vitamin D deficiency is associated with a higher risk of DCGF, infection-related mortality and a faster decline of graft function in kidney transplant recipients.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Post-transplant Circulating 25-Hydroxyvitamin D and Long-term Patient and Graft Outcomes among Kidney Transplant Recipients: The Wisconsin Allograft Recipient Database (WisARD).\",\"authors\":\"Zhongyu Yuan, Sandesh Parajuli, Didier Mandelbrot, Michal L Melamed, Brad C Astor\",\"doi\":\"10.34067/KID.0000000942\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Vitamin D inadequacy at or shortly after kidney transplantation is associated with poor outcomes. Circulating 25-hydroxyvitamin D [25(OH)D] levels generally increase over time after transplantation, but inadequacy remains common. Few studies have examined associations of later circulating 25(OH)D levels and long-term outcomes.</p><p><strong>Methods: </strong>We analyzed data from the Wisconsin Allograft Recipient Database to assess the association of post-transplant 25(OH)D with overall graft failure, death-censored graft failure (DCGF), death with a functioning graft (DWFG), cause-specific mortality and eGFR trajectory over the next 4 years.</p><p><strong>Results: </strong>A total of 2504 recipients who maintained a functioning graft for at least 13 months were included in our analysis. A total of 867 overall graft failures occurred during a median follow-up of 6.8 years. Vitamin D deficiency (≤20 ng/ml) was associated with a 43% higher hazard of overall graft failure (95% confidence interval [CI]: 1.16, 1.78), a 2.24-fold higher hazard of DCGF (95% CI: 1.60, 3.12) and a 2.10-fold higher hazard (95% CI: 1.37, 3.21) of infection-related mortality compared with sufficiency. It also was associated with a 1.38 ml/min/1.73m2/year faster (95% CI: -1.97, -0.79) annual eGFR decline compared with sufficiency. No association was detected for DWFG or other cause-specific mortality.</p><p><strong>Conclusions: </strong>In conclusion, post-transplant vitamin D deficiency is associated with a higher risk of DCGF, infection-related mortality and a faster decline of graft function in kidney transplant recipients.</p>\",\"PeriodicalId\":17882,\"journal\":{\"name\":\"Kidney360\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney360\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.34067/KID.0000000942\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney360","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.34067/KID.0000000942","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Association of Post-transplant Circulating 25-Hydroxyvitamin D and Long-term Patient and Graft Outcomes among Kidney Transplant Recipients: The Wisconsin Allograft Recipient Database (WisARD).
Background: Vitamin D inadequacy at or shortly after kidney transplantation is associated with poor outcomes. Circulating 25-hydroxyvitamin D [25(OH)D] levels generally increase over time after transplantation, but inadequacy remains common. Few studies have examined associations of later circulating 25(OH)D levels and long-term outcomes.
Methods: We analyzed data from the Wisconsin Allograft Recipient Database to assess the association of post-transplant 25(OH)D with overall graft failure, death-censored graft failure (DCGF), death with a functioning graft (DWFG), cause-specific mortality and eGFR trajectory over the next 4 years.
Results: A total of 2504 recipients who maintained a functioning graft for at least 13 months were included in our analysis. A total of 867 overall graft failures occurred during a median follow-up of 6.8 years. Vitamin D deficiency (≤20 ng/ml) was associated with a 43% higher hazard of overall graft failure (95% confidence interval [CI]: 1.16, 1.78), a 2.24-fold higher hazard of DCGF (95% CI: 1.60, 3.12) and a 2.10-fold higher hazard (95% CI: 1.37, 3.21) of infection-related mortality compared with sufficiency. It also was associated with a 1.38 ml/min/1.73m2/year faster (95% CI: -1.97, -0.79) annual eGFR decline compared with sufficiency. No association was detected for DWFG or other cause-specific mortality.
Conclusions: In conclusion, post-transplant vitamin D deficiency is associated with a higher risk of DCGF, infection-related mortality and a faster decline of graft function in kidney transplant recipients.