High prevalence of vitamin A deficiency and vitamin D deficiency in patients evaluated for liver transplantation


Address reprint requests to Samer Gawrieh, M.D., Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226. Telephone: 414-955-6850; FAX: 414-955-6214; E-mail: sgawrieh@mcw.edu


Deficiencies in vitamins A, D, and E have been linked to night blindness, bone health, and post–liver transplant reperfusion injury. The aim of this study was to determine the prevalence and predictive factors of fat-soluble vitamin deficiencies in liver transplant candidates. We reviewed the medical records of liver transplant candidates at our center from January 2008 to September 2011. The etiology of cirrhosis, Model for End-Stage Liver Disease score, Child-Pugh class, body mass index (BMI), and vitamin A, vitamin E, and vitamin 25-OH-D levels were recorded. Patients were excluded for incomplete laboratory data, short gut syndrome, celiac disease, pancreatic insufficiency, or prior liver transplantation. Sixty-three patients were included. The most common etiologies of liver disease were alcohol (n = 23), hepatitis C virus (n = 19), and nonalcoholic steatohepatitis (n = 5). Vitamin A and D deficiencies were noted in 69.8% and 81.0%, respectively. Only 3.2% of the patients were vitamin E–deficient. There were no documented cases of night blindness. Twenty-five of the 55 patients with bone density measurements had osteopenia, and 10 had osteoporosis. Four patients had vertebral fractures. There was 1 case of posttransplant reperfusion injury in a patient with vitamin E deficiency. In a multivariate analysis, there were no statistically significant predictors for vitamin D deficiency. The Child-Pugh class [odds ratio (OR) = 6.84, 95% confidence interval (CI) = 1.52-30.86, P = 0.01], elevated total bilirubin level (OR = 44.23, 95% CI = 5.02-389.41, P < 0.001), and elevated BMI (OR = 1.17, 95% CI = 1.00-1.36, P = 0.045) were found to be predictors of vitamin A deficiency. In conclusion, the majority of liver disease patients evaluated for liver transplantation at our center had vitamin A and D deficiencies. The presence or absence of cholestatic liver disease did not predict deficiencies, whereas Child-Pugh class, bilirubin level, and elevated BMI predicted vitamin A deficiency. Liver Transpl 19:627–633, 2013. © 2013 AASLD.