Cholelithiasis in heart transplant recipients.

The incidence of cholelithiasis is increased in heart transplant recipients. Study aim: 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. Patients and 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 of 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. Conclusion: 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. (C) 2000 Editions scientifiques et medicales Elsevier SAS.