CHOLELITHIASIS IN PANCREAS AND KIDNEY-TRANSPLANT RECIPIENTS WITH DIABETES

Background. Vascularized pancreas transplantation (PTx) for type I dia betes mellitus results in euglycemia at the expense of chronic immunos uppression, hyperinsulinemia, and dyslipidemia. However, the effect of PTx on native biliary lithogenesis remains unknown. Methods. To addre ss this issue, we retrospectively studied 72 consecutive pancreas tran splant recipients and compared them with patients both with (n = 35) a nd without (n = 52) diabetes mellitus undergoing kidney transplantatio n alone (KTA). All patients underwent pretransplantation abdominal ult rasonography, which was repeated at 6- to 12-month intervals after tra nsplantation. PTx recipients were managed with quadruple immunosuppres sion with OKT3 induction. Kidney transplant recipients received cyclos porine and prednisone. Results. Seventeen (30.4%) of 56 evaluable PTx recipients had gallstones at a mean interval of 13 months (range, 5 to 24) after PTx. Eleven patients underwent open cholecystectomy (with o ne surgical exploration of common bile duct for choledocholithiasis), three underwent laparoscopic cholecystectomy, and the other three are being managed expectantly. Gallstone analysis revealed predominantly c holesterol stones. The incidence of cholelithiasis in kidney transplan t recipients with and without diabetes mellitus was 27.3% and 12.2%, r espectively (p = 0.04). Conclusions. Pancreas transplant and kidney tr ansplant recipients with diabetes are predisposed to the development o f gallstones compared with recipients without diabetes. An interaction between diabetes mellitus-induced gallbladder dysmotility and cyclosp orine-induced cholestasis may be a possible mechanism. We recommend se rial ultrasonographic examinations in pancreas transplant and kidney t ransplant recipients, and cholecystectomy in pancreas transplant recip ients with cholelithiasis should be considered.