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Cholelithiasis in pediatric cardiac transplant patients on cyclosporine
S Weinstein1, E C Lipsitz, L Addonizio
1Department of Pediatric Surgery, Babies Hospital, College of Physicians and Surgeons of Columbia University, New York, NY.
Insights
Pediatric heart transplant patients on cyclosporine therapy have an increased risk of developing symptomatic gallstones (cholelithiasis). Biliary tract surgery is generally safe for these patients.
Area of Science:
- Pediatric Gastroenterology
- Transplant Surgery
- Hepatology
Background:
- Cholelithiasis (gallstones) is rare in children (<1% incidence).
- Cyclosporine use in adult transplant recipients is linked to increased gallstone incidence and potential hepatotoxicity.
- Limited data exists on cholelithiasis in pediatric transplant patients, particularly those on cyclosporine.
Purpose of the Study:
- To determine the incidence of symptomatic cholelithiasis in pediatric heart or heart-lung transplant recipients.
- To evaluate the safety and outcomes of biliary tract surgery in this patient population.
- To review the literature on cyclosporine's hepatotoxic effects and its potential role in gallstone formation.
Main Methods:
- Retrospective review of 90 pediatric heart/heart-lung transplant cases from 1984-1993.
- Analysis of patients who developed symptomatic cholelithiasis.
- Review of existing literature on cyclosporine and cholelithiasis in transplant patients.
Main Results:
- Symptomatic cholelithiasis occurred in 6.7% (6/90) of pediatric transplant patients.
- Five patients had successful cholecystectomies.
- One death occurred following emergency biliary sepsis management.
Conclusions:
- Pediatric heart transplant recipients on cyclosporine therapy have a higher incidence of symptomatic cholelithiasis.
- Biliary tract surgery appears to be safe and effective in pediatric cardiac transplant patients.
- Further research into cyclosporine's role in gallstone formation and hepatotoxicity is warranted.
Abstract:
From June 1984 to June 1993, symptomatic chlolethiasis was observed in six (6.7%) of 90 cases of pediatric heart or heart-lung transplants at the author's institution. The incidence of cholelithiasis for all children under 16 years of age is estimated to be less than 1%. Previously, information on cholelithiasis in pediatric transplant patients on cyclosporine therapy had been limited. Studies concerning the incidence of gallstones in adult kidney and cardiac transplant patients have shown that there is an increase associated with cyclosporine, possibly related to elevated levels and hepatoxicity. Five patients underwent uneventful cholecystectomy. There was only one death, which occurred after emergency cholecysostomy tube placement for biliary sepsis. If indicated, biliary tract surgery can be performed safely in cardiac transplant patients. The authors report on their experience with symptomatic cholelithiasis in pediatric cardiac transplant patients and review the current literature on the hepatotoxic effects of cyclosporine.