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Management of biliary tract stones in heart transplant patients
M Milas1, R R Ricketts, J R Amerson
1Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Heart transplant recipients have a high incidence of gallstones, affecting nearly 30% of long-term survivors. Treatment with cholecystectomy is safe and effective in this population.
Area of Science:
- Hepatobiliary surgery
- Transplant medicine
- Gastroenterology
Background:
- Heart transplant patients exhibit a high prevalence of cholelithiasis, with limited treatment consensus and few pediatric studies.
- Hemolysis and cyclosporine use may increase lithogenesis risk in transplant recipients.
- Biliary tract stones pose a significant concern in both adult and pediatric heart transplant populations.
Purpose of the Study:
- To determine the prevalence of biliary tract stones in adult and pediatric heart transplant patients.
- To review management strategies and outcomes for gallstones in this patient cohort.
- To evaluate the safety and efficacy of surgical interventions for biliary tract stones post-heart transplantation.
Main Methods:
- A retrospective chart review of 211 heart transplant patients (January 1988–September 1994).
- Analysis of gallstone prevalence, diagnosis timing, and treatment approaches.
- Assessment of outcomes following cholecystectomy or endoscopic procedures.
Main Results:
- Gallstones were detected in 29.7% of 175 long-term heart transplant survivors (32.8% adults, 15.6% children).
- Symptomatic gallstones occurred in 45% of affected patients, often diagnosed within months post-transplant.
- All patients underwent successful surgical or endoscopic treatment with no reported deaths or complications.
Conclusions:
- Heart transplant recipients have a high prevalence of symptomatic biliary tract stones.
- Open or laparoscopic cholecystectomy is a safe and effective treatment option post-transplantation.
- Routine gallbladder ultrasound screening and elective cholecystectomy are recommended for detected stones.
Objective:
The authors report their experience with biliary tract stones in adult and pediatric heart transplant patients, and review the current literature relative to this problem.
Summary Background Data:
Prior studies in adults have noted that heart transplant patients frequently have cholelithiasis, but offer no consensus about treatment strategy. Few studies exist for pediatric heart transplant patients. A higher rate of hemolysis and cyclosporine-induced changes in bile metabolism may contribute to lithogenesis in this population.
Methods:
A chart review was conducted for 211 patients who had heart transplants between January 1988 and September 1994 to determine prevalence of biliary tract stones, management strategies used, and outcome.
Results:
Of 175 long-term heart transplant survivors, 52 (29.7%) had stones detected: 32.8% of adults (47/143) and 15.6% of children (5/32). The majority of patients (31) were diagnosed 4 months (mean) after transplantation; cholelithiasis developed in 10 of these patients (32%) within 11 months (median) after a negative ultrasound. Symptoms developed in 45% of patients. All patients underwent either elective (36) or urgent (6) cholecystectomy via an open (32) or laparoscopic (10) approach, or endoscopy for common bile duct stones (2). There were no deaths or complications during a follow-up period of up to 7 years.
Conclusion:
Heart transplant patients have a high prevalence of symptomatic biliary tract stone disease. They can be treated safely via an open or laparoscopic approach after transplantation. The authors recommend routine gallbladder ultrasound screening and elective cholecystectomy in the post-transplant period if stones are detected.