Effect of Ramadan fasting on Muslim recipients after living donor liver transplantation: A single center study

Montasser, Iman Fawzy; Dabbous, Hany; Sakr, Mostafa; Ebada, Hend E.; Massoud, Yasmine Mahmoud; Salah, Maged; Faheem, Heba Ahmed; Bahaa, Mohamed; El-Meteini, Mahmoud; Zaky, Doaa Zakaria

doi:10.1016/j.ajg.2020.05.001

Cited by 9 publications

(6 citation statements)

References 5 publications

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“…However, within the fasting group, there was a small but statistically significant rise in creatinine during Ramadan. 19 The clinical risks of fasting in SOT recipients can include dehydration leading to graft dysfunction, rejection due to variable immunosuppression drug levels, hospitalisation, changes in blood pressure, and fluid overload. Although studies have only focused on kidney and liver transplant recipients, the importance of compliance with immunosuppression to maintain graft function and relevance of hydration and fluid management is common to all SOT recipients.…”

Section: Discussion On Existing Datamentioning

confidence: 99%

“…No change in liver function, potassium levels or CyA/tacrolimus trough levels were seen. 19 A retrospective observational cohort study from Qatar reported on safety of fasting in LTR during Ramadan in 2017. Ninety-six patients were included, and biochemical and biopsy results were collected 4 weeks pre-and post-Ramadan and every 2 weeks during Ramadan.…”

Section: Liver Transplantmentioning

confidence: 99%

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Effects of fasting on solid organ transplant recipients during Ramadan – a practical guide for healthcare professionals

et al. 2021

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Fasting in the month of Ramadan is an obligatory act for healthy adult Muslims. It requires abstinence from food and drink from dawn to sunset. Although there are exemptions from fasting, many patients are keen to fulfil what they see as a religious obligation, even if this may be against medical advice in some cases. Solid organ transplant (SOT) recipients often ask healthcare professionals for advice on fasting. Studies on the effect of fasting in transplant patients have all been done in the Middle East and North Africa where the average fasting duration is between 12 and 14 hours. In comparison, in temperate regions in the summer, fasting duration can be as long as 20 hours. Fasting when patients have to take immunosuppression 12 hours apart with little time variation poses unique challenges. In this review, current literature is reviewed, and a decision-making tool has been developed to assist clinicians in discussing the risks of fasting in transplant recipients, with consideration also given to circumstances such as the COVID-19 pandemic.Our review highlights that SOT recipients wishing to fast should undergo a thorough risk assessment, ideally 3 months before Ramadan. They may require medication changes and a plan for regular monitoring of graft function and electrolytes in order to fast safely. Recommendations have been based on risk tiers (very high risk, high risk and low/moderate risk) established by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. Patients in the 'very high risk' and 'high risk' categories should be encouraged to explore alternative options to fasting such as winter fasting

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Section: Discussion On Existing Datamentioning

confidence: 99%

Section: Liver Transplantmentioning

confidence: 99%

Effects of fasting on solid organ transplant recipients during Ramadan – a practical guide for healthcare professionals

et al. 2021

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“…There was a statistically significant difference between the pre‐ and post‐fasting states in terms of the serum creatinine level ( P = .004). The authors concluded that with an adapted immunosuppression protocol, good fluid intake and regular follow‐up LT recipients can observe Ramadan fasting 63 …”

Section: Ramadan Fasting and Liver Transplantationmentioning

confidence: 99%

Ramadan fasting and liver diseases: A review with practice advices and recommendations

Emara

Soliman

Elnadry

et al. 2021

Liver International

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Ramadan fasting is obligatory for Muslim healthy adults. However, there are many exemptions from fasting; including patients, whose diseases will be aggravated by fasting. Muslim patients with different liver diseases are frequently seen in the clinics discussing their intent to fast this month with their treating physicians. To answer our patients’ inquiries about the expected benefits and/or risks of fasting and delivering them the best care, we carried out this review and we draw advices and recommendations based on the available evidence. A web‐based search, combining multiple keywords representing different liver diseases with Ramadan fasting had been carried out. To answer the research question: Do adult Muslim patients with different liver diseases who fast the month of Ramadan have had a deleterious effect on their health in comparison to those who did not fast? Relevant publications were retrieved. No randomized controlled trials were focusing on Ramadan fasting and liver diseases in the filtered databases, eg Cochrane library. Consequently, non‐filtered databases, eg PubMed, Google Scholar and Egyptian Knowledge Bank searched and full‐text high‐quality research articles were carefully analysed to draw recommendations. Other relevant publications with low quality of evidence like case studies and short communications were also reviewed to address practice advices. Although Ramadan fasting was found beneficial for patients with NAFLD, it was found deleterious to patients with Child B and C cirrhosis and patients with peptic ulcer. Patients with chronic hepatitis, Child A cirrhosis and those with non‐complicated liver transplant can fast with prefasting assessment and strict follow up.

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“…Montasser et al [70] assessed the effect of RF on liver transplantation recipients' renal and liver functions and propose a protocol for adapting an immunosuppression regimen and follow-up schedule for patients wishing to fast after liver transplantation. A prospective study was conducted on 45 recipients who wished to fast Ramadan (2018) in Cairo, Egypt.…”

Section: Gut and Livermentioning

confidence: 99%

Ramadan fasting in health and disease (2020): A narrative review

Hafidh

Ali

Beshyah

2021

Ibnosina Journal of Medicine and Biomedical Sciences

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The medical literature on health aspects of Ramadan fasting (RF) is widely spread in many journals of varying access, making it less readily available to those interested in the subject. We performed a nonsystematic review of the international literature from a major online database (PubMed in 1 year [2020]). The search term “Ramadan fasting” was used, and relevant literature was narrated in a concise thematic account excluding diabetes. The publications spanned fundamental, clinical, ethical, professional, cultural, and advocacy facets. The publications predictably crossed the conventional disciplinary lines and geographical locations and appeared in journals with different access systems. The contents are presented under the emerged themes depending on the retrieved literature. This year, the basic coverage included changes in physiology, nutrition during Ramadan. However, the clinical issues included a more comprehensive range such as the impact of RF on the liver and gut, and endocrine conditions such as hypothyroidism and adrenal insufficiency. Coverage also included chronic kidney disease, maternal health and fetal well-being, cardiovascular medicine, nature and function of eyes, and neurological conditions, especially epilepsy. Sports medicine and athletes' well-being received somewhat prominent coverage. Other researchers focused on documenting patients' and health-care professionals' perceptions, attitudes, and practices during Ramadan. Health aspects of RF received a sustained academic interest with a broad spectrum in 2020. This narrative provides a scoping overview to help researchers and clinicians catch up quickly with state-of-the-art science today.

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Effect of Ramadan fasting on Muslim recipients after living donor liver transplantation: A single center study

Cited by 9 publications

References 5 publications

Effects of fasting on solid organ transplant recipients during Ramadan – a practical guide for healthcare professionals

Effects of fasting on solid organ transplant recipients during Ramadan – a practical guide for healthcare professionals

Ramadan fasting and liver diseases: A review with practice advices and recommendations

Ramadan fasting in health and disease (2020): A narrative review

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