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.