Management of biliary tract disease in heart and lung transplant patients

Background. Preexisting gallstones and pharmacologic alterations in, both b ile lithogenicity and immune function may predispose organ transplant recip ients to the complications of biliary calculi. Methods. Records of all 178 patients undergoing heart, lung or heart-lung t ransplantation at our institution between 1980 and 1998 were reviewed. Pati ents with biliary tract disease were grouped as follows: group I, pretransp lantation diagnosis and treatment; group II, pretransplantation diagnosis a nd posttransplantation treatment; group III, normal pretransplantation bili ary tree with posttransplantation diagnosis and treatment; group IV, unknow n pretransplantation biliary status with posttransplantation diagnosis and treatment. Comparison among groups was made with regard to ultrasound findi ngs, presentation, indication for operation, procedure, and outcome. Results. Of the 141 patients undergoing pretransplantation and/or posttrans plantation ultrasound surveillance, the prevalence of abnormal ultrasonogra phy was 36%. All patients in group I (n = 11) underwent elective interventi on without complication. Of the 14 patients (groups II through IV) undergoi ng posttransplantation operation, intervention was mandated by acute compli cations of biliary tract disease in 7 The mortality rate in these 7 patient s was 29%. Conclusions. Cholecystectomy in the posttransplantation period is often req uired emergently and has a high mortality. Posttransplantation surveillance of the biliary tree is crucial because of the high rate of de novo stone f ormation. All biliary calculi should be eradicated electively in stable pat ients before transplantation and on diagnosis after transplantation.