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Prevalence and management of cholelithiasis in heart transplant patients
T B Steck1, M R Costanzo-Nordin, A Keshavarzian
1Department of Medicine, Loyola University Medical School, Maywood, Ill. 60153.
Insights
Heart transplant patients have a high prevalence of gallstones. However, prophylactic cholecystectomy and screening ultrasonography are not recommended for asymptomatic gallstones in this population.
Area of Science:
- Cardiology
- Gastroenterology
- Transplantation Medicine
Background:
- Management of asymptomatic cholelithiasis (gallstones) in heart transplant recipients lacks a standardized approach.
- Gallstones pose potential complications, necessitating evaluation in this vulnerable patient group.
Purpose of the Study:
- To determine the prevalence of cholelithiasis in heart transplant patients.
- To assess the clinical course and outcomes of asymptomatic gallstones post-heart transplantation.
- To inform management strategies for gallstones in heart transplant recipients.
Main Methods:
- Retrospective review of 159 heart transplant patients (March 1984 - January 1990).
- Analysis of biliary tract information, including pre- and post-transplant ultrasonography and cholecystectomy records.
- Multivariate analysis to identify risk factors for gallstones.
Main Results:
- Overall prevalence of cholelithiasis was 29.6% in the studied heart transplant population.
- Only a small minority (7 out of 159) of patients with asymptomatic gallstones developed symptomatic disease requiring cholecystectomy post-transplant.
- Older age was identified as a significant risk factor for gallstones in this cohort.
Conclusions:
- The prevalence of gallstones is high in heart transplant patients, but most asymptomatic cases do not become symptomatic.
- Cholecystectomy can be safely performed if symptomatic gallstones develop post-transplant.
- Routine screening ultrasonography and prophylactic cholecystectomy are not indicated for asymptomatic gallstones in heart transplant recipients.
Abstract:
There is no accepted approach in the field of heart transplantation for the management of asymptomatic cholelithiasis. To help formulate a strategy, we retrospectively reviewed the records of the 159 patients who underwent heart transplantation at our institution from March 1984 to January 1990. Information on the biliary tract was available in 141 (88.7%) of these patients. Before transplantation, 18 (11.3%) had undergone cholecystectomy. Of the 141, 99 (70.2%) had undergone ultrasonographic examination of the biliary tree: 74 (74.8%) had no gallstones seen on ultrasonograms; 8 (8.1%) had sludge; 16 (16.2%) had gallstones; and 1 had a probable polyp. Further information on the biliary tree by ultrasonography became available after transplantation in 24 of 42 patients who did not undergo ultrasonographic examination before transplant. After transplant, gallstones were found by means of ultrasonography or at autopsy in 13 more patients. Seven (4.4%) patients underwent cholecystectomy after transplant because of symptomatic cholelithiasis. Only one of these patients belonged to the group known to have gallstones before transplant. For the entire group, the prevalence of cholelithiasis was 29.6%. Multivariate analysis demonstrated that gallstones were significantly more common in older patients. We conclude that the prevalence of cholelithiasis in the heart transplant population is high but that only a minority of patients with asymptomatic gallstones will become symptomatic after heart transplantation. When they do, cholecystectomy may be safely performed. Prophylactic cholecystectomy and screening ultrasonography are not indicated in patients with asymptomatic cholelithiasis.