NDT Advance Access originally published online on January 5, 2007
Nephrology Dialysis Transplantation 2007 22(3):886-890; doi:10.1093/ndt/gfl708
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Complications of gallstone disease in kidney transplantation patients
1Department of Transplantation and Liver Surgery, Helsinki University Hospital, Helsinki, 2Department of Surgery, Lohja Hospital, Lohja, 3Department of Radiology, Helsinki University Hospital, Helsinki and 4Department of Medicine, Division of Nephrology, Helsinki University Hospital, Helsinki, Finland
Correspondence and offprint requests to: Leena Halme, MD, Department of Transplantation and Liver Surgery, Helsinki University Hospital, Box 263, FIN-00029 Helsinki, Finland. Email: leena.halme{at}hus.fi
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Abstract |
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Background. We studied the complications of gallstone disease in kidney transplantation patients and evaluated whether the screening and treatment of gallstones before acceptance to the kidney waiting list is relevant.
Methods. Complications of gallstone disease were evaluated in 1608 kidney transplantation patients on cyclosporine and long-term steroid treatment with median age 45.5 years, transplanted between 1990 and 2000. To evaluate the prevalence of cholecystolithiasis after kidney transplantation an abdominal ultrasound examination was cross-sectionally performed to a subgroup of 304 patients and the results were correlated to their serum lipid values, changes in BMI and use of statins.
Results. Pre-transplant cholecystectomy due to cholecystolithiasis (prerequisite for acceptance to kidney waiting list) had been performed on 71 (4%) of the patients. Thirty (15%) patients with diagnosed post-transplant gallstones and four without gallstones developed biliary complications. There were 25 cases of cholecystitis of which three resulted in gallbladder perforations. Seventeen patients (50%) with biliary complications required urgent surgery and one (3%) patient died of post-operative complications. In the subgroup of ultrasound examination patients (median 7 years post-transplant follow-up) 81% of the patients had no gallstones and 9% of the patients had gallstones had developed after transplantation. Patients with pre-transplant gallstones were older (P < 0.01) and patients with post-transplant gallstones gained the most weight during the follow-up. No differences in lipid values were found.
Conclusion. In transplantation patients, the complications of gallstone disease may be severe. Screening and treatment of pre- and post-transplantation gallstone disease are recommended.
Keywords: complication; gallstone disease; kidney transplantation
Received for publication: 29.12.05
Accepted in revised form: 31.10.06