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Very low Vitamin D levels after Liver transplant in children (need Calcitriol or topical) – May 2021

Course of vitamin D levels before and after liver transplantation in pediatric patients

Pediatr Transplant. 2021 Jun 2;e14049. doi: 10.1111/petr.14049
Muhammed Yuksel 1 2 3, Bariş Demir 1 2, Özlem Mizikoğlu 1 2, Murat Akyildiz 2, Arzu Baygul 4, Cigdem Arikan 1 2 3


Low vitamin D at week 1 was associated with many more infections
Adding 300,000 IU of oral vitamin D did not apparently help much (no surprise)

Getting Vitamin D into your body has the following chart


Background: 25-hydroxy VD insufficiency is known in children undergoing LT but the serial post-transplant VD course and supplementation modalities in the peri-transplant period are lacking. We aimed to determine the pre-VD status and the post-transplant VD status course following VD supplementation and to elucidate its relationship with post-transplant outcome parameters such as infection and survival.

Methods: Pre- and post-VD levels were monitored in parallel with interventions to adjust VD levels in LT patients. VD status was categorized as circulating levels <30-21 ng/ml (insufficiency), 20-10 ng/ml (deficiency), and <10 ng/ml (severe deficiency). Patients received stoss (300,000 IU) VD3 within the pretransplant period if serum levels were <20 ng/ml.

Results: 135 transplanted children were included. The age at LT was 22 months (IQR: 8-60). The pretransplant median VD level was 14 ng/ml.
Despite stoss dose, post-transplant median VD level was

  • 1.8 ng/ml (day one),
  • 4 ng/ml (week one),
  • 19 ng/ml (month one),
  • 33 ng/ml (month three),
  • 38 ng/ml (months 6-12), and
  • 40 ng/ml (month 24).

After 6 months, VD status reached >30 ng/ml in 98% of patients. Only at pre-LT, higher infection rate (18.7%) in the severe VD deficiency group was observed compared to the VD deficiency group (2.9%, p = .04). Survival was not affected by serum VD levels.

Conclusion: VD levels fell substantially after LT but are rectifiable by stoss dose, which was well tolerated. Only the infection rate was associated with the VD status.


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