[Cholelithiasis in heart transplant patients].
The incidence of cholelithiasis is increased in heart transplant recipients.


OBJECTIVE
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.


METHODS
Over a 9-year period, from January 1991 to December 1999, 27 heart transplant recipients (21 men and 6 women; mean age: 54.6 years, mainly transplanted for ischemic or dilated cardiomyopathy) underwent cholecystectomy. All patients received immunosuppressive therapy with a combination of corticosteroids and cyclosporin and 10 also received azathioprine. Five patients admitted urgently with calculous acute cholecystitis and one 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 laparoscopy, there was no conversion to laparotomy and oral immunosuppressive drugs were continued without interruption. There was one postoperative hemoperitoneum related to liver biopsy performed concomitantly. In patients operated by laparotomy, intravenous cyclosporin was necessary until return to bowel function and the only complication was a wound abscess. Mean length of hospital stay was 3.1 days after laparoscopy and 8.8 days after laparotomy.


CONCLUSIONS
Systematic ultrasound screening of cholelithiasis after heart transplantation 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.
Menegaux
F
F
Service de chirurgie générale et digestive, hôpital de la Pitié, 47-83 boulevard de l'Hôpital, 75651 Paris, France. fabrice.menegaux@psl.ap-hop-paris.fr
Huraux
C
C
Jordi-Galais
P
P
Dorent
R
R
Ghossoub
J J
JJ
Pavie
A
A
Gandjbakhch
I
I
Chigot
J P
JP
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods; D002769:Cholelithiasis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D016896:Treatment Outcome
D007166:Immunosuppressive Agents