TY - JOUR
T1 - Bariatric surgery in solid organ transplant patients
T2 - Long-term follow-up results of outcome, safety, and effect on immunosuppression
AU - Yemini, Renana
AU - Nesher, Eviatar
AU - Winkler, Janos
AU - Carmeli, Idan
AU - Azran, Carmil
AU - Ben David, Matan
AU - Mor, Eytan
AU - Keidar, Andrei
N1 - Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/11
Y1 - 2018/11
N2 - The surgical risk of transplanted patients is high, and the modified gastrointestinal anatomy after bariatric surgery (BS) may lead to pharmacokinetic alterations in the absorption of immunosuppressive drugs. Data on outcomes of BS and the safety and feasibility of maintaining immunosuppression and graft safety among solid organ transplanted patients are scarce. In the current study, weight loss, improvement in comorbidities, and changes in dosage and trough levels of immunosuppression drugs before and after BS were analyzed for all transplanted patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between November 2011 and January 2017. Thirty-four patients (13 females, 21 males, average age 53 years) were included in the study. A successful weight loss (>50% excess weight loss in 28 of them [82%]) was recorded at the last follow-up. Comorbidities improved significantly. Immunosuppressive stability increased from 39% to 47% among all patients. The tacrolimus blood trough levels declined slightly, but remained within therapeutic range. These data suggest that LSG and LRYGB ensure good immunosuppressive maintenance together with significant weight loss and improvement in comorbidities without serious graft rejection or dysfunction. The surgical risk is higher than in the regular BS population.
AB - The surgical risk of transplanted patients is high, and the modified gastrointestinal anatomy after bariatric surgery (BS) may lead to pharmacokinetic alterations in the absorption of immunosuppressive drugs. Data on outcomes of BS and the safety and feasibility of maintaining immunosuppression and graft safety among solid organ transplanted patients are scarce. In the current study, weight loss, improvement in comorbidities, and changes in dosage and trough levels of immunosuppression drugs before and after BS were analyzed for all transplanted patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between November 2011 and January 2017. Thirty-four patients (13 females, 21 males, average age 53 years) were included in the study. A successful weight loss (>50% excess weight loss in 28 of them [82%]) was recorded at the last follow-up. Comorbidities improved significantly. Immunosuppressive stability increased from 39% to 47% among all patients. The tacrolimus blood trough levels declined slightly, but remained within therapeutic range. These data suggest that LSG and LRYGB ensure good immunosuppressive maintenance together with significant weight loss and improvement in comorbidities without serious graft rejection or dysfunction. The surgical risk is higher than in the regular BS population.
KW - clinical decision-making
KW - clinical research/practice
KW - comorbidities
KW - diabetes
KW - immunosuppressant - calcineurin inhibitor (CNI)
KW - obesity
KW - organ transplantation in general
UR - http://www.scopus.com/inward/record.url?scp=85045329517&partnerID=8YFLogxK
U2 - 10.1111/ajt.14739
DO - 10.1111/ajt.14739
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C2 - 29569341
AN - SCOPUS:85045329517
SN - 1600-6135
VL - 18
SP - 2772
EP - 2780
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -