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Liver transplant improves vitamin D, bone mineral density for PSC

ORLANDO — Liver transplant recipients with primary sclerosing cholangitis had improved bone mineral density and higher 25-hydroxyvitamin D levels after transplant compared with before transplant, according to a poster presented at the Advances in Inflammatory Bowel Disease annual conference.

In a retrospective review, researchers from Cleveland Clinic Digestive Disease Institute, including Ramprasad Jegadeesan, MD, analyzed data of 120 patients with primary sclerosing cholangitis (PSC) listed in the Cleveland Clinic liver transplantation database between 1985 and 2013. Variables, such as 25-hydroxyvitamin D levels and bone mineral density (BMD) of lumbar spine and hip were measured before and after liver transplant.

Ramprasad Jegadeesan

"Despite its high frequency especially in patients awaiting liver transplantation, hepatic bone disease is overshadowed by more urgent complications of chronic liver disease and many remain unrecognized unless the diagnosis is specifically sought," Jegadeesan told Healio.com/Gastroenterology. "We wanted to investigate whether liver transplantation improves bone mineral density and 25-hydroxy vitamin D levels by restoring liver-bone homeostasis in PSC patients."

Of all the patients, 59.2% had 25-hydroxyvitamin D levels measured prior to LT (n = 71), of which 78.9% had below average levels (n = 56). About one-third of all patients had BMD data measured before LT (30.8%; n = 37) and of these, 70.3% had below average levels (n = 26). Overall, 24 patients with available before and after data of 25-hydroxyvitamin D levels and 22 with BMD data were included in the final analysis.

Before LT, 17 patients had low 25-hydroxyvitamin D levels, with a mean of 15.1 mg/dL, whereas after LT, two of the 24 patients had low levels, with a mean of 28.1 mg/dL (P < .001). In patients with BMD data, 16 had low density, with a mean of – 2 before LT compared with seven having low density after LT, with a mean of – 1.45 (P = .001).

The mean T scores of the lumbar spine before and after LT were – 1.2 and – 0.4 (P = .02). The mean Z scores before and after LT were – 1.4 and – 0.6 (P = .03). The mean T scores of the hip before and after LT were – 1.4 and – 1.1 (P = .23). The mean Z scores of the hip before and after LT were – 1.3 and – 0.7 (P = .03).

“We found that liver transplantation in PSC patients improved bone mineral density and 25-hydroxy vitamin D levels and was statistically significant," Jegadeesan said. "Improvement in bone mass after liver transplantation might be due to better nutritional status, increase in BMI and from less cholestasis. In PSC patients awaiting liver transplantation, vitamin D deficiency and hepatic bone disease should be specifically sought and treated appropriately to make them a better candidate for undergoing liver transplantation." – by Melinda Stevens

Reference: Jegadeesan R, et al. Abstract P-092. Presented at: Advances in Inflammatory Bowel Diseases; Dec. 10-12, 2015; Orlando, Fla.

Disclosures: Healio Gastroenterology was unable to confirm relevant financial disclosures at the time of publication.