Cholecystectomy in Cardiothoracic Organ Transplant Recipients

• Published in: Archives of surgery (Chicago. 1960) Vol. 133; no. 1; pp. 73 - 79
• Main Authors: Lord, Reginald V. N, Ho, Shirhan, Coleman, Maxwell J, Spratt, Phillip M
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.01.1998
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Child; Cholecystectomy; Cholelithiasis - surgery; Female; Heart Transplantation; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Lung Transplantation; Male; Medical sciences; Middle Aged; Postoperative Complications - mortality; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Cholecystectomy; Heart; Human; Cardiovascular disease; Thorax; Transplantation; Biliary tract disease; Association; Choledoch; Heart disease; Surgery; Risk factor; Lithiasis; Digestive diseases; Gallbladder; Field inquiry
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.133.1.73

OBJECTIVES To assess the risks associated with cholelithiasis and cholecystectomy in cardiothoracic organ transplant recipients at this hospital and to identify any differences with potential causal significance between the group with known gallstones and the transplant recipient group as a whole. DESIGN Medical records survey. SETTING Tertiary care university hospital. PATIENTS Six hundred forty-five patients had cardiothoracic organ transplantation at this hospital between February 1, 1984, and May 31, 1996. Gallstones were detected in 37 (5.7%) of these patients and 32 patients underwent cholecystectomy, of which 29 operations were performed primarily for symptomatic gallstone disease. All cholecystectomies were performed after transplantation. MAIN OUTCOME MEASURES Mortality, morbidity, postoperative biliary disease. RESULTS Patients with gallstones were significantly older than the transplant patient group as a whole (Student t test, P=.001); they were more likely to be female (χ2 test, P=.05); and they had a higher body mass index (t test, P=.001). There were no significant differences in the maximum serum bilirubin level during the transplantation admission, incidence of diabetes mellitus, cholestyramine use, or cyclosporine dosage during the first 12 months after transplantation. Cholecystectomy was performed after a median 5-month symptomatic period, mostly by the minilaparotomy method. Forty-five percent of cholecystectomies were urgent or semi-urgent. One patient died of lung infection on the second postoperative day. The median postoperative stay was 3 days. At a median 33 months' follow-up, 4 patients have had further biliary problems (2 patients with common bile duct stones, 1 patient with intrahepatic stones, and 1 patient with biliary dyskinesia). Four other patients with asymptomatic gallstones who did not receive cholecystectomy have remained asymptomatic for between 15 and 67 months. CONCLUSIONS Cholecystectomy by the minilaparotomy or laparoscopic methods, with routine operative cholangiography, is the preferred treatment for symptomatic gallstones in cardiothoracic organ transplant recipients. Although the optimum management of asymptomatic gallstones in these patients remains unclear, our favorable experience with a policy of reserving cholecystectomy for symptomatic cases seems noteworthy.-->