Laparoscopic cholecystectomy in transplant patients

Acute cholecystitis is a serious condition in transplant patients and elective cholecystectomy is generally recommended when gallstones are found. We reviewed the results of laparoscopic cholecystectomy (LC) in 10 immunosuppressed transplant patients (6 heart, 4 kidney) and compared them to the results of open cholecystectomy performed in 26 transplant patients (14 heart, 11 kidney, 1 kidney/pancreas). The LC group had a 20% incidence of minor complication with no major complications and no deaths. The open-cholecystectomy group experienced 19% minor complications, 23% major complications, and 15% deaths. The average postoperative length of stay for the LC patients was 4.6 days (2 days for the 5 straightforward cases) as compared to 9.1 days after open cholecystectomy (4 days for the 13 straightforward open cases). Oral immunosuppression was stopped prior to operation but could be restarted within 29 hours after operation in the LC patients and 68 h in the open cases. The findings at LC were helpful in assessing whether acute cholecystitis and/or choledocholithiasis was the source of fever, liver-function abnormalities, or pancreatitis in these immunosuppressed transplant patients. We conclude that LC can be performed safely in transplant patients, but that in 10-20% of patients, the operation will be converted to an open procedure. The advantages of LC in these patients are a shorter hospitalization and less delay to resumption of preoperative oral immunotherapy than after open cholecystectomy.