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DOI: 10.1055/s-0029-1223956
Vitamin D deficiency, hyperparathyroidism and bone turnover in patients listed for liver transplantation (LTX): Preliminary results of a cross-sectional study
Background: Although transplantation bone disease is a common complication following liver transplantation (LTX), screening and preventive measures during the pre-transplant period are not part of routine patient care. Aim of the current analysis was to evaluate bone metabolism of liver transplant candidates.
Methods: Currently 30 patients (mean age 57±7) with end stage liver disease (mean MELD 13±4) are in evaluation for LTX and included into the present study. Blood sampling was performed in the morning following an overnight fast. Aside of routine parameters 25-hydroxyvitamin D [vitD], parathyroid hormone [iPTH], bone specific alkaline phosphatase [bALP], osteocalcin [OC], tartrate resistant alkaline phosphatase 5b [TRAP5b] and serum crosslaps [sCTX] levels were analyzed.
Results: Mean VitD serum level of the patient cohort was 17.8±11ng/ml. Only 14% of the patients had levels within the normal range (30–65). Nearly two thirds (64.3%) of the patients had levels below 20ng/ml, indicative of a high prevalence of vitamin D deficiency. Serum VitD levels were negatively correlated to iPTH values [r=-0.58; p=0.001], and 54% of the patients had secondary hyperparathyroidism (sHPT). Patients with sHPT had comparable kidney function and bone formation markers (OC, bALP) when compared to those without sHPT, however, had significantly higher sCTX (p=0.01) and TRAP5b (p=0.005) levels, indicating a negative balance of bone turnover.
Conclusion: Vitamin D deficiency and sHPT are common in patients with end stage liver disease who would very likely benefit from vitamin D supplementation. Evaluation of bone metabolism and eventually DXA measurements should routinely be performed in patients evaluated for LTX.