PREVALENCE AND MANAGEMENT OF CHOLELITHIASIS IN HEART-TRANSPLANT PATIENTS

There is no accepted approach in the field of heart transplantation for the management of asymptomatic cholelithiasis. To help formulate a strategy, we retrospectively reviewed the records of the 159 patients who underwent heart transplantation at our institution from March 1984 to January 1990. Information on the biliary tract was available in 141 (88.7%) of these patients. Before transplantation, 18 (11.3%) had undergone cholecystectomy. Of the 141, 99 (70.2%) had undergone ultrasonographic examination of the biliary tree: 74 (74.8%) had no gallstones seen on ultrasonograms; 8 (8.1%) had sludge; 16 (16.2%) had gallstones; and 1 had a probable polyp. Further information on the biliary tree by ultrasonography became available after transplantation in 24 of 42 patients who did not undergo ultrasonographic examination before transplant. After transplant, gallstones were found by means of ultrasonography or at autopsy in 13 more patients. Seven (4.4%) patients underwent cholecystectomy after transplant because of symptomatic cholelithiasis. Only one of these patients belonged to the group known to have gallstones before transplant. For the entire group, the prevalence of cholelithiasis was 29.6%. Multivariate analysis demonstrated that gallstones were significantly more common in older patients. We conclude that the prevalence of cholelithiasis in the heart transplant population is high but that only a minority of patients with asymptomatic gallstones will become symptomatic after heart transplantation. When they do, cholecystectomy may be safely performed. Prophylactic cholecystectomy and screening ultrasonography are not indicated in patients with asymptomatic cholelithiasis.