The incidence of cholelithiasis is increased in heart transplant recipients
.
Study aim: The aim of this retrospective study was to report a series of 27
heart transplant recipients operated for cholelithiasis and to assess the
indications and safety of cholecystectomy in this population.
Patients and methods: Over a 9-year period, from January 1991 to December 1
999, 27 heart transplant recipients (21 men and 6 women; mean age: 54.6 yea
rs, mainly transplanted for ischemic or dilated cardiomyopathy) underwent c
holecystectomy. All patients received immunosuppressive therapy with a comb
ination of corticosteroids and cyclosporin and 10 also received azathioprin
e. Five patients admitted urgently with calculous acute cholecystitis and o
ne patient with previous gastrectomy underwent laparotomy, while the other
21 patients were operated by laparoscopy.
Results: There were no postoperative deaths. In patients operated by laparo
scopy, there was no conversion to laparotomy and oral immunosuppressive dru
gs were continued without interruption. There was one postoperative hemoper
itoneum related to liver biopsy performed concomitantly. In patients operat
ed by laparotomy, intravenous cyclosporin was necessary until return of bow
el function and the only complication was a wound abscess. Mean length of h
ospital stay was 3.1 days after laparoscopy and 8.8 days after laparotomy.
Conclusion: Systematic ultrasound screening of cholelithiasis after heart t
ransplantation is necessary because cholelithiasis carries a risk of septic
complications in these patients. Laparoscopic cholecystectomy, associated
with a low morbidity, is justified even in asymptomatic cases. In patients
with acute cholecystitis, "open" cholecystectomy must be preferred in order
to minimize the risk of biliary complications which would be very serious
in these immunosuppressed patients. (C) 2000 Editions scientifiques et medi
cales Elsevier SAS.