NDLI: Acute cellular transplant rejection following laparoscopic adjustable gastric banding in a morbidly obese patient post heart transplantation.

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Acute cellular transplant rejection following laparoscopic adjustable gastric banding in a morbidly obese patient post heart transplantation.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Unes Kunju, Shebna Naim, H. Joseph Czer, Lawrence Simsir, Sinan Schwarz, Ernst R.
Description	Country affiliation: United States Author Affiliation: Unes Kunju S ( Division of Cardiology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Suite 6215, Los Angeles, CA 90048, USA.)
Abstract	BACKGROUND: Obesity is a worldwide health problem that is often worsened after organ transplantation. As obesity is associated with increased incidence of metabolic syndrome, cardiovascular events and death, it is essential to control weight and avoid weight gain in patients especially following cardiac transplantation. Of the various strategies that are available for weight reduction, bariatric surgery seems to be the most effective in achieving weight loss and in maintaining the reduced body weight. However, this has not been frequently performed in organ-transplant recipients. CASE REPORT: We are reporting a unique case of a bariatric surgery procedure performed in a patient after cardiac transplantation. A 30-year-old African-American man with a history of end-stage heart failure due to idiopathic dilated cardiomyopathy underwent orthotopic cardiac transplantation. Three years after transplantation, the patient underwent laparoscopic adjustable gastric banding surgery for morbid obesity. Two months later, the patient presented with severe heart failure and was diagnosed with acute cellular rejection as evidenced by endomyocardial biopsy results despite continued combined immunosuppressive therapy that had not been changed but with significantly reduced blood levels of calcineurin inhibitors. CONCLUSION: We hypothesize that the altered gastro-intestinal motility and delayed gastric emptying due to laparoscopic adjustable gastric banding may have caused incomplete absorption of the administered immunosuppressant drugs in this particular case, as evidenced by the low tacrolimus level, resulting in acute cellular rejection of the transplanted heart, which has never been described before.
File Format	HTM / HTML
ISSN	15582027
Issue Number	9
Volume Number	11
e-ISSN	15582035
Journal	Journal of Cardiovascular Medicine
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2010-09-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Cardiology Discipline Vascular Diseases Bariatric Surgery Adverse Effects Cardiomyopathy, Dilated Surgery Graft Rejection Immunology Heart Transplantation Immunity, Cellular Obesity, Morbid Acute Disease Adult Biopsy Complications Gastric Emptying Gastrointestinal Motility Pathology Physiopathology Humans Drug Effects Immunosuppressive Agents Pharmacokinetics Therapeutic Use Male Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Cardiology and Cardiovascular Medicine

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