{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:09:18Z","timestamp":1788858558667,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Obesity after kidney transplantation impairs graft function, but the time course of lean tissue loss after sleeve gastrectomy in this population is poorly described. Methods: A 46-year-old woman underwent sleeve gastrectomy five years after kidney transplantation and was followed for 33 months with bioelectrical impedance analysis (BIA) and three 24-h dietary recalls per visit. Results: Weight fell from 103.4 to 69.4 kg by month 6, with mild regain to 71.9 kg at month 33. BIA-derived fat-free mass, BIA-predicted total muscle mass and BIA-derived skeletal muscle mass reached their lowest recorded values at month 3, each 21.3% below baseline, and were essentially unchanged at month 6; fat-free mass loss corresponded to 34.1% of the weight lost by month 6, above the thresholds proposed for excessive loss in a bariatric cohort which are research rather than clinical definitions. This early loss coincided with three concurrent exposures: energy restriction (521 and 466 kcal\/day at months 1 and 3), protein intake below target during a period of aversion to protein-rich foods (33.2 g\/day against a 60 g\/day target), and absence of structured physical activity; anaemia was present throughout and may have contributed to both. Graft function was clinically stable but not unchanged, with estimated glomerular filtration rate 25% below baseline at month 33 and persistent proteinuria; biopsy was not performed. Conclusions: Early postoperative nutritional vulnerability was temporally associated with substantial lean tissue loss. The estimates are BIA-derived and hydration-dependent, muscle function was not assessed, and the concurrent exposures cannot be separated in a single case, so no causal relationship can be inferred.<\/jats:p>","DOI":"10.3390\/jcm15186940","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:10:22Z","timestamp":1788855022000},"page":"6940","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Lean Tissue Loss and Nutritional Challenges Following Sleeve Gastrectomy in a Kidney Transplant Recipient: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5350-1659","authenticated-orcid":false,"given":"Nida","family":"Y\u0131ld\u0131z","sequence":"first","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Aydin University, Istanbul 34295, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-1386","authenticated-orcid":false,"given":"Halil","family":"Co\u015fkun","sequence":"additional","affiliation":[{"name":"BariatrikLab Obesity and Metabolic Surgery Center, Istanbul 34093, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serpil","family":"G\u00f6r\u00e7in","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Memorial \u015ei\u015fli Hospital, Istanbul 34385, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazl\u0131","family":"Batar","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Kultur University, Istanbul 34158, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015eule","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Aydin University, Istanbul 34295, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halit Tanju","family":"Besler","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Aydin University, Istanbul 34295, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.pcad.2018.07.005","article-title":"Obesity and kidney disease","volume":"61","author":"Lakkis","year":"2018","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/CRD.0000000000000216","article-title":"Obesity in kidney transplantation: Impact on transplant candidates, recipients, and donors","volume":"27","author":"Glicklich","year":"2019","journal-title":"Cardiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E553","DOI":"10.5489\/cuaj.7109","article-title":"The role of bariatric surgery in kidney transplantation: A systematic review and meta-analysis","volume":"15","author":"Lee","year":"2021","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1053\/j.ajkd.2025.06.015","article-title":"Metabolic bariatric surgery in kidney transplant candidates","volume":"86","author":"Kukla","year":"2025","journal-title":"Am. J. Kidney Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.4239\/wjd.v12.i9.1563","article-title":"Bariatric surgery in kidney transplantation: A clinical review","volume":"12","author":"Veroux","year":"2021","journal-title":"World J. Diabetes"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Brzostek, K., and Boniecka, I. (2025). Food intolerance after bariatric surgery: A narrative review of prevalence, mechanisms, and dietary management. Nutrients, 17.","DOI":"10.3390\/nu17193118"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1146\/annurev-nutr-061121-101547","article-title":"Nutritional challenges and treatment after bariatric surgery","volume":"44","author":"Moize","year":"2024","journal-title":"Annu. Rev. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.soard.2016.05.026","article-title":"Inadequate protein intake after laparoscopic sleeve gastrectomy surgery is associated with a greater fat free mass loss","volume":"13","author":"Keidar","year":"2017","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2384","DOI":"10.1111\/ajt.12829","article-title":"Laparoscopic sleeve gastrectomy as a weight reduction strategy in obese patients after kidney transplantation","volume":"14","author":"Golomb","year":"2014","journal-title":"Am. J. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2290","DOI":"10.1002\/oby.23001","article-title":"Effectiveness and safety of bariatric surgery in patients with end-stage chronic kidney disease or kidney transplant","volume":"28","author":"Guggino","year":"2020","journal-title":"Obesity"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.ajt.2025.01.014","article-title":"Association between bariatric surgery after kidney transplantation and graft and survival outcomes","volume":"25","author":"Ku","year":"2025","journal-title":"Am. J. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jclinepi.2013.08.003","article-title":"The CARE guidelines: Consensus-based clinical case report guideline development","volume":"67","author":"Gagnier","year":"2014","journal-title":"J. Clin. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1007\/s11695-023-06703-2","article-title":"Nutrition, physical activity, and prescription of supplements in pre- and post-bariatric surgery patients: An updated comprehensive practical guideline","volume":"33","author":"Tabesh","year":"2023","journal-title":"Obes. Surg."},{"key":"ref_14","unstructured":"Tanita Europe, B.V. (2026, August 16). Understanding Your Measurements. Available online: https:\/\/tanita.eu\/understanding-your-measurements\/muscle-mass."},{"key":"ref_15","unstructured":"BeBiS (Nutrition Information System) (Ebispro for Windows, Stuttgart, Germany, 2010). Ebispro for Windows, Stuttgart, Germany, Turkish version BeBiS 9; Data Bases: Bundeslebensmittelschl\u00fcssel, 11.3 and Other Sources."},{"key":"ref_16","unstructured":"Rak\u0131c\u0131o\u011flu, N., Acar Tek, N., Ayaz, A., and Pekcan, G. (2015). Yemek ve Besin Foto\u011fraf Katalo\u011fu [Food and Meal Photograph Catalogue], Hacettepe University Press. [5th ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"ASMBS Clinical Issues Committee (2015). Standardized outcomes reporting in metabolic and bariatric surgery. Obes. Surg., 25, 587\u2013606.","DOI":"10.1007\/s11695-015-1645-3"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"for the Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C\u2013based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6711","DOI":"10.1097\/JS9.0000000000001800","article-title":"Optimum tacrolimus trough levels for enhanced graft survival and safety in kidney transplantation: A retrospective multicenter real-world evidence study","volume":"110","author":"Han","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1016\/j.ajt.2024.04.013","article-title":"Obesity, organ failure, and transplantation: A review of the role of metabolic and bariatric surgery in transplant candidates and recipients","volume":"24","author":"Ghanem","year":"2024","journal-title":"Am. J. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"464","DOI":"10.4239\/wjd.v8.i11.464","article-title":"Bariatric surgery and long-term nutritional issues","volume":"8","author":"Lupoli","year":"2017","journal-title":"World J. Diabetes"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1007\/s40519-021-01304-3","article-title":"Changes in appetite, taste, smell, and food aversion in post-bariatric patients and their relations with surgery time, weight loss and regain","volume":"27","author":"Lopes","year":"2022","journal-title":"Eat. Weight Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.soard.2019.10.025","article-title":"Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures\u20142019 update","volume":"16","author":"Mechanick","year":"2020","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Potrykus, M., Czaja-Stolc, S., Ma\u0142gorzewicz, S., Proczko-Stepaniak, M., and D\u0119bska-\u015alizie\u0144, A. (2023). Diet management of patients with chronic kidney disease in bariatric surgery. Nutrients, 15.","DOI":"10.3390\/nu15010165"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.clnesp.2021.09.746","article-title":"Ideal body weight: A commentary","volume":"46","author":"Chichester","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3119","DOI":"10.1007\/s11695-020-04654-6","article-title":"Rate and determinants of excessive fat-free mass loss after bariatric surgery","volume":"30","author":"Nuijten","year":"2020","journal-title":"Obes. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13370","DOI":"10.1111\/obr.13370","article-title":"The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta-analysis","volume":"23","author":"Nuijten","year":"2022","journal-title":"Obes. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s40519-025-01761-0","article-title":"The role of nutritional factors in fat-free mass preservation and body composition changes after bariatric surgery: A systematic review of the available evidence","volume":"30","author":"Abiri","year":"2025","journal-title":"Eat. Weight Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1186\/s13643-024-02709-8","article-title":"A systematic review and meta-analysis of factors contributing to post-kidney transplant anaemia and the effect of erythropoietin-stimulating agents","volume":"13","author":"Chienwichai","year":"2024","journal-title":"Syst. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Auge, M., Dejardin, O., Menahem, B., Lee Bion, A., Savey, V., Launoy, G., Bouvier, V., and Alves, A. (2022). Analysis of the lack of follow-up of bariatric surgery patients: Experience of a reference center. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216310"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"sfaf252","DOI":"10.1093\/ckj\/sfaf252","article-title":"Anaemia and iron deficiency in post-kidney transplantation: An unsolved challenge","volume":"18","author":"Oberbauer","year":"2025","journal-title":"Clin. Kidney J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1177\/15269248221145046","article-title":"A systematic review and meta-analysis of posttransplant anaemia with overall mortality and cardiovascular outcomes among kidney transplant recipients","volume":"33","author":"Mekraksakit","year":"2023","journal-title":"Prog. Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1002\/jcsm.12999","article-title":"Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients","volume":"13","author":"Vinke","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/6940\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:30:20Z","timestamp":1788856220000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/6940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,8]]},"references-count":33,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15186940"],"URL":"https:\/\/doi.org\/10.3390\/jcm15186940","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,8]]}}}