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Cholelithiasis in infant and pediatric heart transplant patients
Andreas G Sakopoulos1, Steven Gundry, Anees J Razzouk
1Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
Insights
Pediatric heart transplant recipients, especially infants, have a low incidence of gallstones. Routine screening is recommended for early detection and treatment, with surgery being well-tolerated.
Area of Science:
- Pediatric Cardiology
- Transplant Surgery
- Gastroenterology
Background:
- Cyclosporine A (CsA) immunosuppression is linked to high gallstone incidence in adult solid-organ transplant recipients.
- Cholelithiasis (gallstones) is a potential complication following organ transplantation.
- Limited data exists on gallstone development in pediatric heart transplant (HTx) patients.
Purpose of the Study:
- To investigate the incidence and characteristics of cholelithiasis in pediatric heart transplant recipients.
- To identify risk factors for gallstone development in this patient population.
- To evaluate the management and outcomes of gallstones in children post-heart transplant.
Main Methods:
- Retrospective analysis of 311 pediatric cardiac transplants performed between May 1985 and December 1998.
- Routine abdominal ultrasounds at 3 months, 1 year, and bi-annually post-transplant.
- Documentation of gallstone detection, patient age at transplant, symptoms, and surgical interventions.
Main Results:
- Gallstones were detected in 3.2% (10 of 311) of pediatric heart transplant recipients.
- A significantly higher incidence (8%) was observed in infants transplanted younger than 3 months (p < 0.05).
- Most patients (80%) were younger than 3 months at transplant; only 20% were symptomatic. Cholecystectomy was well-tolerated.
Conclusions:
- Pediatric post-transplant cholelithiasis is uncommon but strongly associated with early infancy heart transplantation.
- Routine abdominal ultrasound screening is recommended for infant heart transplant recipients.
- Surgical treatment (laparoscopic or open cholecystectomy) for gallstones is safe and effective in pediatric heart transplant patients.
Abstract:
There have been numerous studies which demonstrate a relatively high incidence of gallstones in adult solid-organ transplant recipients receiving cyclosporin A (CsA) immunosuppression. The purpose of the present study was to investigate our experience with cholelithiasis in babies and children undergoing heart transplant (HTx). From May 1985 to December 1998, 311 neonatal and pediatric cardiac transplants were performed at our institution. Routine abdominal ultrasound was performed at 3 months, 1 yr, and bi-annually thereafter on all transplant recipients. Asymptomatic or symptomatic gallstone development was detected during abdominal ultrasound in 10 of 311 patients (3.2%). Eight of these 10 patients (80%) were transplanted when younger than 3 months of age. Eight per cent of all infants transplanted at < 3 months of age developed cholelithiasis (p < 0.05 compared to older age at HTx). Fifty per cent of gallstones were detected and treated within 6 months post-HTx, while the remaining 50% of patients with gallstones underwent cholecystectomy 3-6 yr later. Only 20% (two of 10) had symptoms of cholelithiasis/cholecystitis. Five patients (50%) underwent laparoscopic cholecystectomy. Only one patient older than 1 yr of age, who was symptomatic, underwent open cholecystectomy. There were no complications from surgery. There were no differences in liver function tests or cholesterol levels in transplant recipients with or without gallstones, and all mean values were within normal limits. Hence, although the incidence of pediatric post-transplant cholelithiasis in infant and pediatric heart transplant recipients is low, almost all occurrences are associated with HTx during early infancy and, because of this, patients in this group should be routinely screened. Laparoscopic or open cholecystectomy are extremely well tolerated and we recommend that surgery be performed when cholelithiasis is found in pediatric heart treatment patients.