Management of Asymptomatic Gallstones in Renal Transplantation

Ru Da Lee; Seok Hwa Youn; Dong Hoon Shin

doi:10.4285/jkstn.2014.28.3.160

Journal List > J Korean Soc Transplant > v.28(3) > 1034429

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Youn, and Shin: Management of Asymptomatic Gallstones in Renal Transplantation

Original Article

J Korean Soc Transplant 2014;28(3):160-164.

Published online: 10 September 2014

DOI: https://doi.org/10.4285/jkstn.2014.28.3.160

Management of Asymptomatic Gallstones in Renal Transplantation

Ru Da Lee, M.D., Seok Hwa Youn, M.D., Dong Hoon Shin, Ph.D.

Hepato-Biliary-Pancreas Center and Division of Transplantation, Department of General Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea

Corresponding author: Dong Hoon Shin Hepato-Biliary-Pancreas Center and Division of Transplantation, Department of General Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 602-702, Korea Tel: 82-51-990-6462, Fax: 82-51-246-6093 E-mail: surgeonshin@naver.com

Received 15 June 2014 Revised 2 September 2014 Accepted 12 September 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

In solid organ transplantation patients, complications of cholelithiasis may run a fulminant course, resulting in high morbidity and mortality under immunosuppression and may even result in rejection. Here, we reviewed medical records of 66 patients in order to determine the outcome of management approach for asymptomatic gallstones in renal transplantation patients.

Methods

We retrospectively reviewed clinical courses of 66 cases of renal transplantation performed between 2000 and 2012 at Kosin University Gospel Hospital.

Results

Among 66 cases, eight had gallstones before transplantation. Three of these cases had undergone previous cholecystectomy for symptomatic gallstones, one had a simultaneous laparoscopic cholecystectomy and renal transplantation, and four were observed by regular abdominal ultrasonography. One patient was found to have cholangitis, and endoscopic retrograde biliary drainage was performed, resulting in alleviation of symptoms. Among 58 cases without preoperative gallstones, three developed gallstones after transplantation. One patient had cholecystitis, and the symptoms subsided after conservative treatment.

Conclusions

For patients with asymptomatic gallstones who are awaiting renal transplantation, expectant management should be considered.

Keywords: Kidney transplantation, Prophylactic laparoscopic cholecystectomy, Gallstones

References

1). Chung YJ, Park YD, Lee HC, Cho HJ, Park KS, Seo EH, et al. Prevalence and risk factors of gallstones in a general health screened population. Korean J Med. 2007; 72:480–90.

2). Diehl AK. Epidemiology and natural history of gallstone disease. Gastroenterol Clin North Am. 1991; 20:1–19.

3). Juvonen T. Pathogenesis of gallstones. Scand J Gastroenterol. 1994; 29:577–82.

4). Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989; 42:127–36.

5). Fendrick AM, Gleeson SP, Cabana MD, Schwartz JS. Asymptomatic gallstones revisited. Is there a role for laparoscopic cholecystectomy? Arch Fam Med. 1993; 2:959–68.

6). Ransohoff DF, Gracie WA. Treatment of gallstones. Ann Intern Med. 1993; 119(7 Pt 1):606–19.

7). Bhatia DS, Bowen JC, Money SR, Van Meter CH Jr, McFadden PM, Kot JB, et al. The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation. Ann Surg. 1997; 225:686–93.

8). Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993; 165:399–404.

9). Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med. 1982; 307:798–800.

10). Gupta D, Sakorafas GH, McGregor CG, Harmsen WS, Farnell MB. Management of biliary tract disease in heart and lung transplant patients. Surgery. 2000; 128:641–9.

11). Peterseim DS, Pappas TN, Meyers CH, Shaeffer GS, Meyers WC, Van Trigt P. Management of biliary complications after heart transplantation. J Heart Lung Transplant. 1995; 14:623–31.

12). Spes CH, Angermann CE, Beyer RW, Schreiner J, Lehnert P, Kemkes BM, et al. Increased incidence of cholelithiasis in heart transplant recipients receiving cyclosporine therapy. J Heart Transplant. 1990; 9:404–7.

13). Steck TB, Costanzo-Nordin MR, Keshavarzian A. Prevalence and management of cholelithiasis in heart transplant patients. J Heart Lung Transplant. 1991; 10:1029–32.

14). Graham SM, Flowers JL, Schweitzer E, Bartlett ST, Imbembo AL. The utility of prophylactic laparoscopic cholecystectomy in transplant candidates. Am J Surg. 1995; 169:44–8.

15). DeIorio T, Thompson A, Larson GM, Bentley FR, Miller F. Laparoscopic cholecystectomy in transplant patients. Surg Endosc. 1993; 7:404–7.

16). Banli O, Guvence N, Altun H. Laparoscopic cholecystectomy for renal transplants. Transplant Proc. 2005; 37:2127–8.

17). Sianesi M, Capocasale E, Ferreri G, Mazzoni MP, Dalla Valle R, Busi N. The role of cholecystectomy in renal transplantation. Transplant Proc. 2005; 37:2129–30.

18). Jackson T, Treleaven D, Arlen D, D'Sa A, Lambert K, Birch DW. Management of asymptomatic cholelithiasis for patients awaiting renal transplantation. Surg Endosc. 2005; 19:510–3.

19). Lieber MM. The incidence of gallstones and their correlation with other diseases. Ann Surg. 1952; 135:394–405.

20). Gupta SK, Shukla VK. Silent gallstones: a therapeutic dilemma. Trop Gastroenterol. 2004; 25:65–8.

21). Maio R, Carraca J, Batista L, Aldeia F, Costa P, Guerra J, et al. Laparoscopic cholecystectomy and renal transplantation. Transplant Proc. 2003; 35:1100–1.

22). Lowell JA, Stratta RJ, Taylor RJ, Bynon JS, Larsen JL, Nelson NL. Cholelithiasis in pancreas and kidney transplant recipients with diabetes. Surgery. 1993; 114:858–63.

23). Hudson HM 2nd, Hakaim AG, Birkett DH. Laparoscopic cholecystectomy in a renal transplant recipient. Surg Endosc. 1992; 6:193–4.

24). Greenstein SM, Katz S, Sun S, Glicklich D, Schechner R, Kutcher R, et al. Prevalence of asymptomatic cholelithiasis and risk of acute cholecystitis after kidney transplantation. Transplantation. 1997; 63:1030–2.

25). McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg. 1985; 202:59–63.

26). Melvin WS, Meier DJ, Elkhammas EA, Bumgardner GL, Davies EA, Henry ML, et al. Prophylactic cholecystectomy is not indicated following renal transplantation. Am J Surg. 1998; 175:317–9.

27). Kao LS, Flowers C, Flum DR. Prophylactic cholecystectomy in transplant patients: a decision analysis. J Gastrointest Surg. 2005; 9:965–72.

28). Cao S, Cox K, So SS, Berquist W, Lee SP, Haigh WG, et al. Potential effect of cyclosporin A in formation of cholesterol gallstones in pediatric liver transplant recipients. Dig Dis Sci. 1997; 42:1409–15.

29). Helderman JH, Goral S. Gastrointestinal complications of transplant immunosuppression. J Am Soc Nephrol. 2002; 13:277–87.

30). Lorber MI, Van Buren CT, Flechner SM, Williams C, Kahan BD. Hepatobiliary complications of cyclosporine therapy following renal transplantation. Transplant Proc. 1987; 19(1 Pt 2):1808–10.

31). Kao LS, Kuhr CS, Flum DR. Should cholecystectomy be performed for asymptomatic cholelithiasis in transplant patients? J Am Coll Surg. 2003; 197:302–12.

32). Sutariya V, Tank A. An audit of laparoscopic cholecystectomy in renal transplant patients. Ann Med Health Sci Res. 2014; 4:48–50.

33). Choi SJ, Noh JH, Yoo HS, Chung SY, Cho CK, Lee WJ, et al. Simultaneous laparoscopic cholecystectomy and kidney transplantation: report of two cases. Transplant Proc. 2003; 35:319–20.

Fig. 1.

Distribution of diagnosed gallstones in renal transplantation patients. Abbreviation: KTP, renal transplantation.

Table 1.

Clinical characteristics

Clinical characteristic	No. (%)
Total no. of patients	66
Male	37 (56.1)
Female	29 (43.9)
Mean age at transplantation (yr)	47.6
Cause of dialysis
GN	35 (53)
DN	7 (10.6)
PCKD	1 (1.5)
Systemic disease include HTN ^a	15 (22.7)
Other nephropathy ^b	8 (12.1)

Abbreviations: GN, glomerulonephritis; DN, diabetic nephropathy; PCKD, polycystic kidney disease; HTN, hypertension.

^a HTN, Autoimmune disease;

^b Obstructive nephropathy, membranous nephropathy.

TOOLS

Similar articles