title: Acute cellular transplant rejection following laparoscopic adjustable gastric banding in a morbidly obese patient post heart transplantation.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Suite 6215, Los Angeles, CA 90048, USA.
authors.forename: Shebna
authors.initials: S
authors.lastname: Unes Kunju
authors.forename: H Joseph
authors.initials: HJ
authors.lastname: Naim
authors.forename: Lawrence
authors.initials: L
authors.lastname: Czer
authors.forename: Sinan
authors.initials: S
authors.lastname: Simsir
authors.forename: Ernst R
authors.initials: ER
authors.lastname: Schwarz
mesh_terms: D000208:Acute Disease; D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000601:surgery*; D005746:Gastric Emptying; D005769:Gastrointestinal Motility; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology / Q000503:physiopathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*
chemical_list: D007166:Immunosuppressive Agents