Yodoshi T. Navigating liver transplantation after malabsorptive bariatric surgery: A new risk of rejection. World J Transplant 2026; 16(2): 114837 [DOI: 10.5500/wjt.v16.i2.114837]
Corresponding Author of This Article
Toshifumi Yodoshi, MD, PhD, Advanced Nutrition Fellow, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States. toshifumi.yodoshi@cchmc.org
Research Domain of This Article
Transplantation
Article-Type of This Article
editorial
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Yodoshi T. Navigating liver transplantation after malabsorptive bariatric surgery: A new risk of rejection. World J Transplant 2026; 16(2): 114837 [DOI: 10.5500/wjt.v16.i2.114837]
World J Transplant. Jun 18, 2026; 16(2): 114837 Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.114837
Navigating liver transplantation after malabsorptive bariatric surgery: A new risk of rejection
Toshifumi Yodoshi
Toshifumi Yodoshi, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
Author contributions: Yodoshi T contributed to the concept, design, manuscript writing, and editing, as well as the review of the literature.
Conflict-of-interest statement: The author declares that he has no conflict of interest to disclose.
Corresponding author: Toshifumi Yodoshi, MD, PhD, Advanced Nutrition Fellow, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States. toshifumi.yodoshi@cchmc.org
Received: September 29, 2025 Revised: December 4, 2025 Accepted: January 7, 2026 Published online: June 18, 2026 Processing time: 242 Days and 7.3 Hours
Core Tip
Core Tip: Malabsorptive bariatric surgery (for example, Roux-en-Y gastric bypass and duodenal switch) is increasingly common among liver transplant candidates. Chang et al report significantly higher rates, frequency, and earlier onset of biopsy-proven acute cellular rejection in recipients with prior malabsorptive anatomy, despite comparable perioperative outcomes and one-year survival. This editorial explores plausible mechanisms-especially impaired absorption of oral immunosuppressants-and outlines pragmatic strategies: Intensified therapeutic drug monitoring, dose and formulation adjustments (including extended-release tacrolimus), and multidisciplinary nutrition-pharmacy support to reduce rejection and protect long-term graft function.
