Prophylactic cholecystectomy in transplant patients: a decision analysis

Area of Science:

• Transplant Surgery
• Gastroenterology
• Medical Decision Making

Background:

• Asymptomatic cholelithiasis (gallstones) is common in solid organ transplant recipients.
• Management strategies include expectant observation, pre-transplant, or post-transplant prophylactic cholecystectomy.

Purpose of the Study:

• To evaluate the optimal management strategy for asymptomatic cholelithiasis in cardiac and pancreas/renal transplant patients.
• To compare clinical outcomes and costs of different prophylactic cholecystectomy approaches.

Main Methods:

• Decision analytic modeling was employed to analyze management strategies.
• Probabilities and outcomes were derived from a pooled analysis of published studies.
• Sensitivity and cost-effectiveness analyses were conducted.

Main Results:

• Post-transplant prophylactic cholecystectomy is favored for cardiac recipients (5 deaths/1000) over pre-transplant (80 deaths/1000) or expectant management (44 deaths/1000).
• Expectant management is favored for pancreas/renal recipients (2 deaths/1000) over prophylactic cholecystectomy (5 deaths/1000).
• Post-transplant cholecystectomy offers cost savings ($17,779/QALY) for heart transplant patients.

Conclusions:

• Prophylactic post-transplant cholecystectomy is the preferred strategy for cardiac transplant patients with asymptomatic gallstones.
• Expectant management is the preferred strategy for pancreas and/or kidney transplant recipients with asymptomatic gallstones.