CHOLECYSTECTOMY IN CARDIOTHORACIC ORGAN TRANSPLANT RECIPIENTS

Objectives: To assess the risks associated with cholelithiasis and cho lecystectomy in cardiothoracic organ transplant recipients at this hos pital and to identify any differences with potential causal significan ce between the group with known gallstones and the transplant recipien t group as a whole. Design: Medical records survey. Setting: Tertiary care university hospital. Patients: Six hundred forty-five patients ha d cardiothoracic organ transplantation at this hospital between Februa ry 1, 1984, and May 31, 1996. Gallstones were detected in 37 (5.7%) of these patients and 32 patients underwent cholecystectomy, of which 29 operations were performed primarily for symptomatic gallstone disease . All cholecystectomies were performed after transplantation. Main Out come Measures: Mortality, morbidity, postoperative biliary disease. Re sults: Patients with gallstones were significantly older than the tran splant patient group as a whole (Student t test, P=.001); they were mo re likely to be female (chi(2) test, P=.05); and they had a higher bod y mass index (t test, P=.001). There were no significant differences i n the maximum serum bilirubin level during the transplantation admissi on, incidence of diabetes mellitus, cholestyramine use, or cyclosporin e dosage during the first 12 months after transplantation. Cholecystec tomy was performed after a median 5-month symptomatic period, mostly b y the minilaparotomy method. Forty-five percent of cholecystectomies w ere urgent or semi-urgent. One patient died of lung infection on the s econd postoperative day. The median postoperative stay was 3 days. At a median 33 months' follow-up, 4 patients have had further biliary pro blems (2 patients with common bile duct stones, 1 patient with intrahe patic stones, and 1 patient with biliary dyskinesia). Four other patie nts with asymptomatic gallstones who did not receive cholecystectomy h ave remained asymptomatic for between 15 and 67 months. Conclusions: C holecystectomy by the minilaparotomy or laparoscopic methods, with rou tine operative cholangiography, is the preferred treatment for symptom atic gallstones in cardiothoracic organ transplant recipients. Althoug h the optimum management of asymptomatic gallstones in these patients remains unclear, our favorable experience with a policy of reserving c holecystectomy for symptomatic cases seems noteworthy.