Gallstone Disease in Heart Transplant Recipients

William S. Richardson, MD, Walter J. Surowiec, MD, Kristine M. Carter, MD, Todd P. Howell, MD, Mandeep R. Mehra, MD, John C. Bowen, MD


Annals of Surgery. 2003;237(2) 

In This Article

Abstract and Introduction

Objective: To review the outcome of cholecystectomy after heart transplant.
Summary Background Data: The optimal timing for gallbladder surgery in heart transplant patients is controversial.
Methods: Between April 1985 and October 2000, 518 cardiac transplants were performed at Ochsner Foundation Hospital. Data gathered included ultrasound reports, cholecystectomy operative reports, gallbladder pathologic reports, complications, and deaths.
Results: Charts were available for 509 patients (98%), 68 (13%) of whom underwent cholecystectomy before transplantation. Of the 509, 53 (10%) had serial ultrasound examinations and 29 of the 53 (55%) developed gallstones. After transplant, 47 (9%) underwent cholecystectomy. Five cholecystectomies were performed during the immediate postoperative course. Two patients who underwent cholecystectomy had acalculous cholecystitis; one was incidental. Four patients died (one with rejection and three with sepsis). After discharge, 42 cholecystectomies were performed: 16 for biliary colic (no deaths, three patients with complications), 19 for acute cholecystitis (one death, nine patients with complications), 5 for biliary pancreatitis (1 death, 1 patient with complications), and 2 others.
Conclusions: The risk of morbidity and mortality from gallstone disease is high in cardiac transplant patients, particularly immediately posttransplant. Posttransplant patients require annual ultrasound examinations to detect the onset of gallstone disease, and this risk is higher than in the general population. Gallstones alone are an indication for cholecystectomy in the cardiac transplant patient. Pretransplant cholecystectomy should be considered in clinically stable patients with gallstones.

The first laparoscopic cholecystectomy was performed in the United States in 1988. Since then the rate of cholecystectomy has risen, and approximately 500,000 cholecystectomies are performed in the United States each year.[1] The increase in acceptance of this procedure is due to the shortened recovery compared with open cholecystectomy.

As with many procedures, there are no large prospective randomized studies of open versus laparoscopic cholecystectomy, but the laparoscopic procedure has become the gold standard. Laparoscopic cholecystectomy can be performed relatively safely on patients with severe cardiac disease and patients after cardiac transplant.[2,3,4,5,6,7] The optimal timing of surgery and indications in the cardiac transplant patient remain controversial.

We retrospectively reviewed our large experience to understand the morbidity of cholecystectomy in heart transplant patients with the goal of creating a clinical strategy for identifying and treating cholelithiasis in these patients. We have included our current perioperative management of heart transplant patients and our current treatment strategy.


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