TY - JOUR
AU1 - Reichrath, Jörg
AB - It has been shown during the last years that transplant recipients may develop vitamin D deficiency.1,2 Although the reasons for relatively low vitamin D levels in transplant recipients are thought to be multifactoral, I believe that a lack of UV exposure may be the major cause. Exposure to UV is the main reason for the development of nonmelanoma skin cancer.3 Because immunosuppressive therapy markedly increases the risk of developing UV-induced skin cancer, it is extremely important for transplant recipients to protect themselves against UV exposure. On the other hand, 90% of all vitamin D is formed within the skin through the action of the sun. This is a serious problem, as a connection between vitamin D deficiency and severe health problems, including various types of cancer (eg, colon, prostate, and breast cancer), has been suggested in a large number of studies.4,5 As a consequence, the association between vitamin D deficiency and various internal malignancies has now opened a debate among clinicians regarding the necessity to detect and treat vitamin D deficiency in transplant recipients more agressively. What is the rationale for an association between vitamin D deficiency and an increased risk of certain types of cancer? A negative association has been reported between increased risk of dying of various internal malignancies (eg, breast, colon, prostate, and ovarian cancer) and living at decreasing degrees of latitude.4,5 Additionally, a correlation of this latitudinal association with decreased vitamin D serum levels has been shown.4 It has now been demonstrated that, in contrast to earlier assumptions, skin, prostate, colon, breast, and many other tissues express an enzyme (25-hydroxyvitamin D [25(OH)D]-1α-hydroxylase) that converts 25(OH)D to its active form, 1,25(OH)2D.6,7 Therefore 1,25(OH)2D is now not exclusively considered a calciotropic hormone but also a locally produced regulator of cell growth.6,7 Consequently, recently published studies point to a protective effect of locally produced vitamin D in the pathogenesis of various malignancies. In conclusion, there is mounting evidence that it is extremely important to detect and treat vitamin D deficiency in transplant recipients. Recommendations for oral treatment of vitamin D deficiency have been published.8,9 It has been shown that a single dose of 50 000 IU of a synthetic form of vitamin D once per week for 8 weeks is efficient and safe to treat vitamin D deficiency. A means of maintaining vitamin D sufficiency is to give 50 000 IU of synthetic vitamin D once a month. If we follow these guidelines, transplant recipients will be sufficiently protected against the serious health problems caused by vitamin D deficiency without increasing their risk of developing UV-induced skin cancer. The author has no relevant financial interest in this article. Correspondence: Dr Reichrath, Department of Dermatology, the Saarland University Hospital, 66421 Homburg/Saar, Germany (hajrei@uniklinik-saarland.de). References 1. Massenkeil GFiene CRosen OMichael RReisinger WArnold R Loss of bone mass and vitamin D deficiency after hematopoietic stem cell transplantation: standard prophylactic measures fail to prevent osteoporosis Leukemia. 2001;151701- 1705PubMedGoogle ScholarCrossref 2. Segal EBaruch YKramsky RRaz BIsh-Shalom S Vitamin D deficiency in liver transplant patients in Israel Transplant Proc. 2001;332955- 2956PubMedGoogle ScholarCrossref 3. De Gruijl FR Photocarcinogenesis: UVA vs UVB radiation Skin Pharmacol Appl Skin Physiol. 2002;15316- 320PubMedGoogle ScholarCrossref 4. Garland CFComstock GWGarland FC et al. Serum 25-hydroxyvitamin D and colon cancer: eight year prospective study Lancet. 1989;21176- 1178PubMedGoogle ScholarCrossref 5. Grant WB An estimate of premature cancer mortality in the US due to inadequate doses of solar ultraviolet-B radiation Cancer. 2002;941867- 1875PubMedGoogle ScholarCrossref 6. Schwartz GGWhitlatch LWChen TCLokeshwar BLHolick MF Human prostate cells synthesize 1,25-dihydroxyvitamin D3 from 25-hydroxyvitamin D3 Cancer Epidemiol Biomarkers Prev. 1998;7391- 395PubMedGoogle Scholar 7. Tangpricha VFlanagan JNWhitlatch LW et al. 25-Hydroxyvitamin D-1α-hydroxylase in normal and malignant colon tissue Lancet. 2001;3571673- 1674PubMedGoogle ScholarCrossref 8. Vieth R Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety Am J Clin Nutr. 1999;69842- 856PubMedGoogle Scholar 9. Malabanan AVeronikis IEHolick MF Redefining vitamin D insufficiency Lancet. 1998;351805- 806PubMedGoogle ScholarCrossref
TI - UV Protection and Vitamin D Deficiency in Transplant Recipients
JF - Archives of Dermatology
DO - 10.1001/archderm.140.8.1015
DA - 2004-08-01
UR - https://www.deepdyve.com/lp/american-medical-association/uv-protection-and-vitamin-d-deficiency-in-transplant-recipients-pvfTWkC1OX
SP - 1015
EP - 1016
VL - 140
IS - 8
DP - DeepDyve
ER -