title: Management of asymptomatic cholelithiasis for patients awaiting renal transplantation.
abstract: BACKGROUND
  There is no consensus regarding the most appropriate management of asymptomatic cholelithiasis in patients awaiting renal transplantation. Cholecystectomy is considered before renal transplantation because of potential worsened complications from cholelithiasis with posttransplantation immunosuppression. This study reviewed the outcomes for operative and nonoperative management of asymptomatic cholelithiasis in patients awaiting renal transplantation.
  
  
  METHODS
  A retrospective chart review of all patients who received renal transplant at the authors' institution during the period 1994 to 2000 was completed. All patients underwent pretransplantation abdominal ultrasound.
  
  
  RESULTS
  Of the 411 patients receiving renal transplants (242 men and 169 women with a mean age of 45.7 years), 32 had cholelithiasis at the pretransplantation workup (7.8%), and 35 had gallbladder abnormalities (8.5%): polyps, thickened wall, sludge, bile duct dilation. Before transplantation, 12 of the 32 patients (38%) with cholelithiasis underwent uncomplicated cholecystectomy. None of the remaining 19 patients with cholelithiasis required cholecystectomy after renal transplantation (mean follow-up period 6.2 years). Of the 35 patients with gallbladder abnormalities, 2 required post transplantation elective cholecystectomy.
  
  
  CONCLUSIONS
  No evidence was found for increased morbidity related to cholelithiasis or gallbladder abnormalities after renal transplantation. As in the general population, the risks associated with asymptomatic cholelithiasis do not appear to warrant prophylactic cholecystectomy for patients awaiting renal transplantation.
authors.affiliation: Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Jackson
authors.forename: D
authors.initials: D
authors.lastname: Treleaven
authors.forename: D
authors.initials: D
authors.lastname: Arlen
authors.forename: A
authors.initials: A
authors.lastname: D'Sa
authors.forename: K
authors.initials: K
authors.lastname: Lambert
authors.forename: D W
authors.initials: DW
authors.lastname: Birch
mesh_terms: D000328:Adult; D019090:Case Management; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015897:Comorbidity; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015995:Prevalence; D012189:Retrospective Studies; D014463:Ultrasonography; D019564:Unnecessary Procedures