title: Management of biliary complications after heart transplantation.
abstract: BACKGROUND
  Immunosuppression increases the risk of biliary complications in heart transplant recipients.
  
  
  METHODS
  Patients undergoing heart transplantation since 1986 who were at risk for cholelithiasis (n = 60) were retrospectively studied.
  
  
  RESULTS
  Cholestatic jaundice developed in all patients after the operation because of biliary obstruction from cholelithiasis, cyclosporine toxicity, Imuran toxicity, or Gilbert's disease. The incidence of cholelithiasis or sludge was 42% (n = 25 of 60). Gallstones developed within 1.8 +/- 1.1 years in 17% of patients (n = 8 of 48) with a normal pretransplantation ultrasonogram. Biliary colic or gallstone pancreatitis developed 2 +/- 1.2 years after transplantation in 58% of patients (n = 7 of 12) with asymptomatic gallstones diagnosed before transplantation. The overall incidence of cholecystectomy or cholecystectomy with Roux-en-Y cystojejunostomy was 40% (n = 24). Both open cholecystectomy (n = 5) and laparoscopic cholecystectomy (n = 19) were performed without significant complications. Recovery is significantly more rapid (p < 0.05) after laparoscopic cholecystectomy versus open cholecystectomy (1 week versus 3 weeks).
  
  
  CONCLUSIONS
  This analysis indicates that transplant candidates who have gallstones on pretransplantation evaluation or in whom gallstones develop after transplantation should undergo laparoscopic cholecystectomy at the earliest time in their posttransplantation course (i.e., 3 months) regardless of their symptomatic status. Removal of the diseased gallbladder not only simplifies the evaluation of cholestatic jaundice by eliminating the need for multiple ultrasonograms to exclude acute cholecystitis or choledocholithiasis but also safely minimizes the risk of the development of severe biliary complications.
authors.affiliation: Department of General and Thoracic Surgery, Duke University Medical Center, Durham, N.C. 27710, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Peterseim
authors.forename: T N
authors.initials: TN
authors.lastname: Pappas
authors.forename: C H
authors.initials: CH
authors.lastname: Meyers
authors.forename: G S
authors.initials: GS
authors.lastname: Shaeffer
authors.forename: W C
authors.initials: WC
authors.lastname: Meyers
authors.forename: P
authors.initials: P
authors.lastname: Van Trigt
mesh_terms: D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D002648:Child; D002675:Child, Preschool; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery; D005260:Female; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents