PROPHYLACTIC CHOLECYSTECTOMY IS NOT INDICATED FOLLOWING RENAL-TRANSPLANTATION

BACKGROUND: The appropriate management of gallstones in patients under going renal transplantation is controversial. Screening for gallstones and subsequent prophylactic cholecystectomy has been recommended by s ome authors for kidney transplant candidates. Our program does not pra ctice routine pretransplant screening for gallstones, and we reviewed our data to determine the outcome of our management approach. METHODS: We reviewed the records of the 1,364 currently followed patients who have undergone kidney transplant at our institution since 1985 in orde r to evaluate the morbidity and mortality of biliary disease in the po st-transplant period. We attempted to contact all patients by telephon e or mail survey for the presence of biliary tract disease or operatio ns. RESULTS: SIX hundred and sixty-two patients were fully evaluated. Fifty-two (7.85%) required cholecystectomy for stone disease. Seven pa tients underwent incidental cholecystectomy during other operations, 2 patients developed acalculus cholecystitis, and 14 patients with asym ptomatic cholelithiasis are being followed up. Surgical indications in cluded 38 biliary colic, 9 acute cholcystitis, 3 gallstone pancreatiti s, and 2 patients who were asymptomatic. Fifty-two patients underwent 30 laparoscopic cholecystectomies, 20 open cholecystectomies, and 2 co nversions. Surgery occurred from 7 days to 9.6 years following transpl antation. Overall, the median hospital stay (no postoperative stay) wa s 4 days (range 1 to 57), Patients undergoing laparoscopy had a median stay of 2 days compared with 7 days for those undergoing an open proc edure. Complications were seen in 6 patients (11.5%) with no morbidity and no graft loss. The 1-, 2-, and 5-year graft survival was 98%, 96% , and 85%, respectively, in patients undergoing cholecystectomy, CONCL USIONS: Transplant patients are slot at an increased risk for developi ng biliary tract disease compared with nontransplant patients. Gallsto ne disease does not have a negative impact on graft survival. Treatmen t of gallstones has a low risk and does not represent an increased ris k of complications in patients following renal transplantation. (C) 19 98 by Excerpta Medica, Inc.