Background

Vitamin D (VitD) deficiency is associated with several diseases such as multiple sclerosis, rheumatoid arthritis, respiratory infection, and so forth. In the field of transplantation (kidney transplantation), some studies reported that patients with VitD deficiency are of increased chance of acute rejection, but other studies did not show such a chance. On the other hand, since VitD is a modulatory factor and can reduce the inflammatory response, understanding the exact role of it in transplantation may contribute to tolerance condition in these patients.

Methods

The electronic databases, including PubMed, Scopus, Embase, ProQuest, Web of Science, and Google Scholar, were searched for eligible studies. In general, 14 studies with a total of 4770 patients were included in this meta-analysis. Regarding the methodological heterogeneity, we selected a random-effects combination model. Moreover, OR was chosen as an effect size for this study.

Results

After the combination of 14 studies, we showed that patients in the VitD-deficient group had an 82% increased chance of acute rejection compared with patients in the VitD-sufficient group, and this effect was significant (OR 1.82; 95% confidence interval [CI] [1.29, 2.56]; I² = 52.3%). This result was significant, and, regarding the narrow CI, it can be a conclusive result. Study quality and gender variables were the main sources of inconsistent results in the primary studies. Moreover, using meta-regression, we showed that VitD deficiency (independent from the estimated glomerular filtration rate (eGFR) of patients) increased the chance of acute rejection.

Conclusion

The normal VitD status of patients a few days before and after transplantation can reduce the chance of acute rejection.

中文翻译：

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维生素 D 与人肾移植急性排斥反应的相关性：系统评价和荟萃分析研究

背景

维生素 D (VitD) 缺乏症与多种疾病有关，例如多发性硬化症、类风湿性关节炎、呼吸道感染等。在移植（肾移植）领域，一些研究报告说VitD缺乏的患者发生急性排斥反应的机会增加，但其他研究并没有显示这种机会。另一方面，由于 VitD 是一种调节因子，可以减少炎症反应，了解它在移植中的确切作用可能有助于这些患者的耐受状况。

方法

搜索了包括 PubMed、Scopus、Embase、ProQuest、Web of Science 和 Google Scholar 在内的电子数据库，寻找符合条件的研究。总的来说，这项荟萃分析包括 14 项研究，共 4770 名患者。关于方法异质性，我们选择了随机效应组合模型。此外，选择OR作为本研究的效应量。

结果

经过 14 项研究的组合，我们发现与 VitD 充足组患者相比，VitD 缺乏组患者发生急性排斥反应的几率增加了 82%，并且这种效果是显着的（OR 1.82；95% 置信区间 [ CI] [1.29, 2.56]；I ²  = 52.3%）。这个结果很重要，对于狭窄的 CI，它可以是一个决定性的结果。研究质量和性别变量是主要研究结果不一致的主要来源。此外，使用元回归，我们发现 VitD 缺乏（独立于患者估计的肾小球滤过率 (eGFR)）增加了急性排斥反应的机会。

结论

移植前后几天患者的正常VitD状态可以减少急性排斥反应的机会。