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Vitamins A, D deficiencies common among patients evaluated for liver transplantation

Most liver transplant candidates are vitamin A- and vitamin D-deficient, with bilirubin levels, BMI and Child-Turcotte-Pugh class predictive of vitamin A deficiency, according to a recent study.

Researchers performed a retrospective chart review of 63 patients who underwent liver transplantation at a single medical facility between January 2008 and September 2011. Demographic information was collected and levels of vitamins A, E and 25-OH-D were assessed, along with BMI, MELD score and Child-Turcotte-Pugh (CTP) class.

The majority of patients were vitamin A (69.8% of cases)- and vitamin E-deficient (80.9%), while few participants had vitamin E deficiency (3.2%). Four patients had severe vitamin D deficiency (less than 10 ng/mL), and 57.1% of the cohort were vitamins A and D deficient.

One vitamin E-deficient patient experienced reperfusion injury post-transplant. No night blindness was observed. Among 55 participants who underwent bone density measurement, osteoporosis was observed in 10 cases, osteopenia in 25 and vertebral fractures in four. Vitamin D deficiency occurred in all participants with osteoporosis or vertebral fractures, 72% of those with osteopenia and 80% of those with normal bone density. Among 11 patients with cirrhosis and CTP class C, all cases were vitamin A-deficient.

Multivariate analysis indicated that high BMI (OR=1.17; 95% CI, 1.00-1.36) and total bilirubin levels (OR=44.23; 95% CI, 5.02-389.41), along with CTP class (OR=6.84; 95% CI, 1.52-30.86) were predictive of vitamin A deficiency, while no evaluated factors were predictive of vitamin D deficiency. An AUROC of 0.91 (0.84-0.98) was determined for a model incorporating BMI, bilirubin and CTP class.

“Our study confirms that deficiency of vitamin A and D in patients with [end-stage liver disease] awaiting liver transplantation is very common,” the researchers wrote. “Etiology of liver disease did not predict vitamin deficiency; however, severity of liver disease impacted vitamin A deficiency.

“If our findings are validated in other studies, universal screening for vitamin A and D in this population being evaluated for liver transplantation may be reasonable given the high prevalence of these deficiencies.”