Abstract
Background. Preexisting gallstones and pharmacologic alterations in both bile lithogenicity and
immune function may predispose organ transplant recipients to the complications of
biliary calculi. Methods. Records of all 178 patients undergoing heart, lung, or heart-lung transplantation
at our institution between 1980 and 1998 were reviewed. Patients with biliary tract
disease were grouped as follows: group I, pretransplantation diagnosis and treatment;
group II, pretransplantation diagnosis and posttransplantation treatment; group III,
normal pretransplantation biliary tree with posttransplantation diagnosis and treatment;
group IV, unknown pretransplantation biliary status with posttransplantation diagnosis
and treatment. Comparison among groups was made with regard to ultrasound findings,
presentation, indication for operation, procedure, and outcome. Results. Of the 141 patients undergoing pretransplantation and/or posttransplantation ultrasound
surveillance, the prevalence of abnormal ultrasonography was 36%. All patients in
group I (n = 11) underwent elective intervention without complication. Of the 14 patients
(groups II through IV) undergoing posttransplantation operation, intervention was
mandated by acute complications of biliary tract disease in 7. The mortality rate
in these 7 patients was 29%. Conclusions. Cholecystectomy in the posttransplantation period is often required emergently and
has a high mortality. Posttransplantation surveillance of the biliary tree is crucial
because of the high rate of de novo stone formation. All biliary calculi should be
eradicated electively in stable patients before transplantation and on diagnosis after
transplantation. (Surgery 2000;128:641-9.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart transplantation is associat-ed with an increased risk for pancreaticobiliary disease.Ann Intern Med. 1996; 124: 980-983
- The natural history of silent gall-stones.N Engl J Med. 1982; 307: 798-800
- Prevalence and management of cholelithiasis in heart transplant patients.J Heart Lung Transplant. 1991; 10: 1029-1032
- Gastrointestinal disease following heart transplantation.World J Surg. 1999; 23: 650-656
- Significance of asymptomatic biliary tract disease in heart transplant recipients.Journal of Heart Transplantation. 1989; 8: 391-399
- Optimal timing and indications for cholecystectomy in cardiac transplant patients.World J Surg. 1995; 19: 661-667
- Management of biliary tract stones in heart transplant patients.Ann Surg. 1996; 223: 747-756
- Hepatobiliary complications of cyclosporine therapy following renal transplantation.Transplant Proc. 1987; 19: 1808-1810
- Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients.Transplantation. 1987; 43: 35-40
- Cholestasis after cyclosporine A and glucose administration: beneficial effect of canrenoate (soldactone).Transplant Proc. 1988; 20: 160-161
- Cyclosporine A hepatotoxicity: effect of prolonged treatment with cyclosporine on biliary lipid secretion in the rat.Clin Exp Pharmacol Physiol. 1995; 22: 260-265
- The association between cholesterol cholelithiasis and coronary heart disease in Framingham, Massachusetts.Am J Epidemiol. 1985; 121: 19-28
- Cholelithiasis in pancreas and kidney transplant recipients with diabetes.Surgery. 1993; 114: 858-864
- Biliary surgery after heart transplantation.Am J Surg. 1998; 175: 320-321
- The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation.Ann Surg. 1997; 225: 686-694
- The utility of prophylactic laparoscopic cholecystectomy in transplant candidates.Am J Surg. 1995; 169: 44-49
- Biliary surgery after cardiac transplantation.Arch Surg. 1991; 126: 571-573
- Management of biliary complications after heart transplantation.J Heart Lung Transplant. 1995; 14: 623-631
- Cholecystectomy in the potential heart transplant patient.J Heart Lung Transplant. 1991; 10: 269-274
Article info
Footnotes
*Reprint requests: Michael B. Farnell, MD, Professor of Surgery, Department of Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
**Surgery 2000;128:641-9
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
