Kumar A, Mahapatra HS. Letter to the Editor: Post-transplant diabetes mellitus prevention in renal transplantation - are we missing vitamin D? World J Nephrol 2026; 15(2): 117674 [DOI: 10.5527/wjn.v15.i2.117674]
Corresponding Author of This Article
Adarsh Kumar, DM, MD, Associate Professor, Department of Nephrology and Renal Transplant Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar East, Near AIIMS Metro Station, New Delhi 110029, India. adarshnephro081@gmail.com
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Transplantation
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letter
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Kumar A, Mahapatra HS. Letter to the Editor: Post-transplant diabetes mellitus prevention in renal transplantation - are we missing vitamin D? World J Nephrol 2026; 15(2): 117674 [DOI: 10.5527/wjn.v15.i2.117674]
World J Nephrol. Jun 25, 2026; 15(2): 117674 Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.117674
Letter to the Editor: Post-transplant diabetes mellitus prevention in renal transplantation - are we missing vitamin D?
Adarsh Kumar, Himansu Sekhar Mahapatra
Adarsh Kumar, Department of Nephrology and Renal Transplant Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
Himansu Sekhar Mahapatra, Department of Nephrology, Atal Bihari Vajpayee Institute of Medical Science and Dr Ram Manohar Lohia Hospital, New Delhi 110001, India
Author contributions: Kumar A conceptualized the letter and drafted the manuscript; Mahapatra HS critically revised the letter; both authors approved the final manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Corresponding author: Adarsh Kumar, DM, MD, Associate Professor, Department of Nephrology and Renal Transplant Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar East, Near AIIMS Metro Station, New Delhi 110029, India. adarshnephro081@gmail.com
Received: December 15, 2025 Revised: January 22, 2026 Accepted: February 13, 2026 Published online: June 25, 2026 Processing time: 184 Days and 10.1 Hours
Abstract
Post-transplant diabetes mellitus (PTDM) affects 10% to 40% of solid organ transplant recipients and is associated with adverse graft and cardiovascular outcomes. We read with interest the observational study published in the World Journal of Nephrology by Singh et al. This study suggests an association between vitamin D status and the risk of post-transplant diabetes mellitus. Evidence from the general population demonstrates that low serum 25-hydroxyvitamin D levels are associated with an increased risk of type 2 diabetes mellitus. Vitamin D deficiency affects over 80% of patients with end-stage kidney disease and commonly persists after transplantation. Vitamin D deficiency may worsen post-transplant glucose control by impairing anti-inflammatory pathways, reducing insulin sensitivity, and compromising pancreatic β-cell function. These actions are particularly important in patients receiving calcineurin inhibitors and glucocorticoids, which are major contributors to impaired insulin secretion. In PTDM, vitamin D status merits renewed attention as a modifiable factor influencing post-transplant glycemic control. Well-designed supplementation trials are needed to determine whether correcting vitamin D deficiency can meaningfully reduce PTDM incidence and improve graft outcomes.
Core Tip: Vitamin D deficiency is nearly universal among kidney transplant recipients (RTRs) but remains underappreciated as a contributor to post-transplant diabetes mellitus (PTDM). Recent evidence shows that low pre- and early post-transplant vitamin D levels independently increase PTDM risk. Integrating vitamin D optimization into transplant care may offer a simple strategy to prevent PTDM and improve long-term graft outcomes. Doses of vitamin D necessary to achieve a serum 25-hydroxyvitamin D concentration of ≥ 30 ng/mL in RTRs are much higher than those recommended in the general population. Vitamin D repletion is a safe, inexpensive, and widely accessible intervention that may enhance insulin secretion, improve insulin sensitivity, and attenuate the metabolic toxicity associated with calcineurin inhibitors and glucocorticoids. Further well-designed prospective studies are needed to elucidate underlying mechanisms and evaluate the impact of vitamin D supplementation on PTDM.
