Publication Name	World Journal of Transplantation
Manuscript ID	114837
Country	United States

Category	Transplantation
Manuscript Type	Editorial
Article Title	Navigating liver transplantation after malabsorptive bariatric surgery: A new risk of rejection
Manuscript Source	Invited Manuscript
All Author List	Toshifumi Yodoshi
Funding Agency and Grant Number
Corresponding Author	Toshifumi Yodoshi, MD, PhD, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, United States. toshifumi.yodoshi@cchmc.org
Key Words	Metabolic dysfunction-associated steatotic liver disease; Liver fibrosis; Liver transplantation; Bariatric surgery; Acute cellular rejection; Immunosuppression management; Therapeutic drug monitoring
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.
Citation	Yodoshi T. Navigating liver transplantation after malabsorptive bariatric surgery: A new risk of rejection. World J Transplant 2026; In press

Received	2025-09-29 01:46
Peer-Review Started	2025-09-29 01:46
First Decision by Editorial Office Director	2025-12-03 10:12
Return for Revision	2025-12-03 10:12
Revised	2025-12-04 17:49
Publication Fee Transferred
Second Decision by Editor	2026-01-06 02:39
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-01-07 02:11
Articles in Press	2026-01-07 02:11
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2220-3230 (online)
Open Access	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Copyright	©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Permissions	For details, please visit: http://www.wjgnet.com/bpg/gerinfo/207
Publisher	Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Website	http://www.wjgnet.com