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Prophylactic cholecystectomy is not indicated following renal transplantation
W S Melvin1, D J Meier, E A Elkhammas
1Department of Surgery, Ohio State University, Columbus 43210, USA.
Insights
Management of gallstones in kidney transplant recipients is debated. This study found gallstone disease does not increase post-transplant complications or negatively impact graft survival, suggesting conservative management is safe.
Area of Science:
- Nephrology
- Transplant Surgery
- Gastroenterology
Background:
- Management of gallstones in renal transplant recipients remains controversial.
- Some recommend pretransplant screening and prophylactic cholecystectomy.
- This study evaluates outcomes without routine pretransplant gallstone screening.
Purpose of the Study:
- To assess the morbidity and mortality associated with biliary tract disease in kidney transplant patients.
- To determine the impact of gallstone disease and its treatment on post-transplant outcomes.
- To evaluate the safety of managing gallstones in this patient population.
Main Methods:
- Retrospective review of 1,364 kidney transplant recipients followed since 1985.
- Evaluation of biliary disease and surgical interventions post-transplantation.
- Patient contact via telephone or mail survey for data collection.
Main Results:
- Of 662 fully evaluated patients, 7.85% (52) required cholecystectomy for gallstones.
- Surgical indications included biliary colic, acute cholecystitis, and gallstone pancreatitis.
- Cholecystectomy, including laparoscopic procedures, had low complication rates and no graft loss; 1-, 2-, and 5-year graft survival was 98%, 96%, and 85% respectively.
Conclusions:
- Kidney transplant recipients do not face an increased risk of biliary tract disease compared to the general population.
- Gallstone disease and its treatment do not adversely affect kidney graft survival.
- Treatment for gallstones in transplant patients carries a low risk of complications.
Background:
The appropriate management of gallstones in patients undergoing renal transplantation is controversial. Screening for gallstones and subsequent prophylactic cholecystectomy has been recommended by some authors for kidney transplant candidates. Our program does not practice routine pretransplant screening for gallstones, and we reviewed our data to determine the outcome of our management approach.
Methods:
We reviewed the records of the 1,364 currently followed patients who have undergone kidney transplant at our institution since 1985 in order to evaluate the morbidity and mortality of biliary disease in the post-transplant period. We attempted to contact all patients by telephone or mail survey for the presence of biliary tract disease or operations.
Results:
Six hundred and sixty-two patients were fully evaluated. Fifty-two (7.85%) required cholecystectomy for stone disease. Seven patients underwent incidental cholecystectomy during other operations, 2 patients developed acalculus cholecystitis, and 14 patients with asymptomatic cholelithiasis are being followed up. Surgical indications included 38 biliary colic, 9 acute cholcystitis, 3 gallstone pancreatitis, and 2 patients who were asymptomatic. Fifty-two patients underwent 30 laparoscopic cholecystectomies, 20 open cholecystectomies, and 2 conversions. Surgery occurred from 7 days to 9.6 years following transplantation. Overall, the median hospital stay (no postoperative stay) was 4 days (range 1 to 57). Patients undergoing laparoscopy had a median stay of 2 days compared with 7 days for those undergoing an open procedure. Complications were seen in 6 patients (11.5%) with no morbidity and no graft loss. The 1-, 2-, and 5-year graft survival was 98%, 96%, and 85%, respectively, in patients undergoing cholecystectomy.
Conclusions:
Transplant patients are not at an increased risk for developing biliary tract disease compared with nontransplant patients. Gallstone disease does not have a negative impact on graft survival. Treatment of gallstones has a low risk and does not represent an increased risk of complications in patients following renal transplantation.