Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression

Abstract

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.

Outcomes after renal transplantation of obese patients: a French cohort-based study

“…Therefore, despite we reported worst short-and long-term an increased risk of death after transplantation due to obesity, we could not conclude that it is preferable to maintain patients on dialysis. Nevertheless, considering their risk of comorbidity and death it would be probably useful to help severe obese candidates with BMI above 35 in losing weight, for instance by using bariatric surgery [28]. Dietary intervention for obese patients with a lower BMI before transplantation remains debatable [29].…”

Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant

“…[6][7][8][9][10][11][12][13][14][15][16][17] Furthermore, benefits among specific organ transplant subtypes include stabilization or improvement in kidney graft function for kidney transplant recipients and decreased liver graft steatosis and fibrosis for liver transplant recipients with history of nonalcoholic fatty liver disease. [18][19][20][21] However, the perioperative safety of bariatric surgery among patients with history of solid organ transplant is poorly understood, because small studies have poor generalizability and may fail to detect rare events. Reported short-term complications in single-center studies include anastomotic leak, bleeding, infection, unplanned reoperation, intensive care unit stay, and death.…”

“…Reported short-term complications in single-center studies include anastomotic leak, bleeding, infection, unplanned reoperation, intensive care unit stay, and death. 6,8,[14][15][16][17]21,22 Yet these studies have no comparison cohorts, and therefore the marginal risk of these outcomes imparted by previous solid organ transplant status remains unknown. Preoperative kidney disease is more common in solid organ transplant recipients, adding to the baseline perioperative risk.…”

What about drug bioavailability in patients who had bariatric surgery and dependent on immunosuppressives?

“…But there are certain reports that sleeve gastrectomy, and gastric bypass does not cause serious graft rejection or dysfunction; although they effect through levels of certain IS medications. 3 In this aspect, we at least suggest addition of data about bioavailability of tacrolimus, sirolimus, and cyclosporine, in which plasma level can be measured.This additional analysis would benefit not only Tx patients but also certain patients with autoimmune or rheumatological diseases who are dependent on IS medications and are candidates for bariatric surgery as an adjunctive treatment modality. 4 ORCID Baris Yildiz https://orcid.org/0000-0001-7625-8663…”

“…But there are certain reports that sleeve gastrectomy, and gastric bypass does not cause serious graft rejection or dysfunction; although they effect through levels of certain IS medications. 3 In this aspect, we at least suggest addition of data about bioavailability of tacrolimus, sirolimus, and cyclosporine, in which plasma level can be measured.…”