Objectives: To report the safety and feasibility of maintaining immunosuppression and graft safety after bariatric surgery among solid organ transplanted patients.

Summary Background Data: Transplanted patients comprise a special population with a high prevalence of obesity. The modified gastrointestinal anatomy after bariatric surgery may lead to significant pharmacokinetic alterations in the oral absorption of immunosuppressive drugs. Data on anti-rejection management after bariatric operations are scarce.

Methods: A retrospective chart review of prospectively collected data was conducted to analyze changes in dosage and trough levels of immunosuppression drugs before and after bariatric operations. The transplanted patients underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (RYGB) in our institution between 11/2011–1/2016. The reported outcome included blood tacrolimus trough levels, tacrolimus dosage, and the weight and graft outcomes with a follow-up of 6 months to 4.5 years.

Results: Thirty patients (12 females, 18 males, average age 54 years) were included in the study. Immunosuppressive stability increased from 62% to 77% among all patients. Those values rose from 54% to 65% for the laparoscopic RYGB group, and from 66% to 83% for the LSG group. Patients with normal-range trough levels tended to stay balanced after surgery and preoperative abnormal values persisted as well. The blood trough levels of tacrolimus declined slightly, but remained within therapeutic range. Conclusions: Our results suggest that LSG and laparoscopic RYGB ensure good immunosuppressive maintenance together with significant weight loss, without serious graft rejection or dysfunction.

CITATION INFORMATION: Keidar A, Yemini R, Carmeli I, Nesher E, Vinkler J, Mor E, Bendavid M. Long-Term Follow-Up of the Safety and Effects of Bariatric Surgery on Immunosuppression in Post-Transplant Patients. Am J Transplant. 2017;17 (suppl 3).

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