title: Gallstone disease in heart transplant recipients.
abstract: OBJECTIVE
  To review the outcome of cholecystectomy after heart transplant.
  
  
  BACKGROUND
  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.
authors.affiliation: Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA. wrichardson@ochsner.org
authors.forename: William S
authors.initials: WS
authors.lastname: Richardson
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Surowiec
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Carter
authors.forename: Todd P
authors.initials: TP
authors.lastname: Howell
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.forename: John C
authors.initials: JC
authors.lastname: Bowen
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000379:methods / Q000401:mortality; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006331:Heart Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography