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Gallstone disease in heart transplant recipients
William S Richardson1, Walter J Surowiec, Kristine M Carter
1Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA. wrichardson@ochsner.org
Insights
Gallstone disease poses a high risk for heart transplant recipients, especially post-transplant. Annual ultrasounds are recommended, and cholecystectomy (gallbladder removal) is advised for gallstones, with pre-transplant surgery considered.
Area of Science:
- Transplant Surgery
- Gastroenterology
- Hepatology
Background:
- The optimal timing for gallbladder surgery in heart transplant recipients remains a subject of debate.
- Gallstone disease presents a significant risk in this immunocompromised population.
Purpose of the Study:
- To evaluate the outcomes of cholecystectomy in patients who have undergone heart transplantation.
- To determine the risks associated with gallstone disease in heart transplant recipients.
Main Methods:
- A retrospective review of 518 cardiac transplant patients between April 1985 and October 2000.
- Data collection included ultrasound reports, operative details, pathology, complications, and mortality.
Main Results:
- Of 509 patients, 68 (13%) had pre-transplant cholecystectomy, and 47 (9%) had post-transplant surgery.
- Post-transplant cholecystectomy showed significant morbidity (36% complication rate) and mortality (2.4%).
- Gallstone disease was detected in 55% of patients undergoing serial ultrasounds post-transplant.
Conclusions:
- Gallstone disease carries a high risk of morbidity and mortality in heart transplant patients, particularly in the immediate post-transplant period.
- Annual ultrasound screening for gallstones is crucial for post-transplant patients.
- Cholecystectomy is indicated for gallstones, and pre-transplant surgery should be considered for stable patients.
Objective:
To review the outcome of cholecystectomy after heart transplant.
Summary Background Data:
The optimal timing for gallbladder surgery in heart transplant patients is controversial.
Methods:
Between April 1985 and October 2000, 518 cardiac transplants were performed at Ochsner Foundation Hospital. Data gathered included ultrasound reports, cholecystectomy operative reports, gallbladder pathologic reports, complications, and deaths.
Results:
Charts were available for 509 patients (98%), 68 (13%) of whom underwent cholecystectomy before transplantation. Of the 509, 53 (10%) had serial ultrasound examinations and 29 of the 53 (55%) developed gallstones. After transplant, 47 (9%) underwent cholecystectomy. Five cholecystectomies were performed during the immediate postoperative course. Two patients who underwent cholecystectomy had acalculous cholecystitis; one was incidental. Four patients died (one with rejection and three with sepsis). After discharge, 42 cholecystectomies were performed: 16 for biliary colic (no deaths, three patients with complications), 19 for acute cholecystitis (one death, nine patients with complications), 5 for biliary pancreatitis (1 death, 1 patient with complications), and 2 others.
Conclusions:
The risk of morbidity and mortality from gallstone disease is high in cardiac transplant patients, particularly immediately posttransplant. Posttransplant patients require annual ultrasound examinations to detect the onset of gallstone disease, and this risk is higher than in the general population. Gallstones alone are an indication for cholecystectomy in the cardiac transplant patient. Pretransplant cholecystectomy should be considered in clinically stable patients with gallstones.