POTENTIAL EFFECT OF CYCLOSPORINE-A IN FORMATION OF CHOLESTEROL GALLSTONES IN PEDIATRIC LIVER-TRANSPLANT RECIPIENTS

Recent advancements in Liver transplantation have resulted in extended survival both for grafts and recipients. Such improvement, together w ith the shortage of donor organs has prompted expansion of the donor p ool to include less than ideal donors, especially in life-threatening situations. The use of older fiver donors has been associated with low er long-term survival. However, potential morbidity such as gallstone formation has not been explored. We analyzed bile composition in a chi ld who developed cholesterol gallstones in the proximal bile duct two years after undergoing emergency liver transplantation with a liver fr om a 78-year-old donor. Oral administration of ursodeoxycholic acid (u rsodiol) shifted the cholesterol composition of the bile from a supers aturated, potentially crystallized state to a liquid (micellar) state. Unlike cyclosporin A, FK506 showed an increase in the proportion of c henodeoxycholic acid and a decrease in the proportion of cholic acid, and thus may exhibit minimal or no hepatotoxic effect. Thus, in donor livers with factors known to be associated with cholesterol gallstone formation (such as age, sex, or obesity), one may consider analyzing t he bile composition at the time of procurement. Depending on cholester ol and bile acid composition, the use of FK506 with or without additio n of ursodeoxycholic acid may be warranted.