PATHOPHYSIOLOGY AND TREATMENT OF GALLSTONE DISEASE IN ORGAN TRANSPLANT RECIPIENTS

Biliary calculous disease represents one of the most important causes of surgical morbidity within the Western population, and debate regard ing optimal management has continued since the early 1990's, The rapid growth in application of clinical transplantation associated with the introduction of cyclosporine (CsA) during the 1980's further complica ted the discussion, Hepatotoxicity, usually reversible abnormality in liver function, was identified early as an important side effect of Cs A. Effective management has usually been accomplished with CsA dose re duction, but a significant association with development of biliary cal culous disease was noted among renal and cardiac transplant recipients . Observations have additionally suggested a rapid de novo development of biliary stones among some patients, and working hypotheses suggest an etiologic relationship with CsA induced cholestasis. Opinions have been mixed, however, the evidence has suggested substantial morbidity and increased mortality among transplant recipients who develop bilia ry calculous disease, It has been demonstrated that cholecystectomy ca n proceed in a safe and effective manner among most patients during th e pre- or post transplant period. Therefore, an aggressive approach to management of cholelithiasis is recommended for this high risk patien t population.