Abstract • Many patients have undergone successful cardiac transplantation. These patients are at risk of developing the same surgical diseases as the general population. The side effects of immunotherapy may mandate intervention at a different point in the natural history of these processes. From February 1984 through December 1989, 24 patients underwent an operative biliary tract procedure following cardiac transplantation. Seventeen patients underwent elective cholecystectomy with intraoperative cholangiography. The mean hospital stay was 5.4 days, and there was no morbidity or mortality. Seven patients underwent urgent procedures; four of them developed severe complications and three died as a result of their biliary tract disease. Two patients in the urgent group had previously exhibited symptoms of biliary tract disease, and five were previously asymptomatic. There was no significant difference in time from transplantation to biliary procedure between the elective group (mean, 17 months; range, 3 weeks to 47 months) and the urgent group (mean, 18 months; range, 3 weeks to 44 months). Patients who undergo cardiac transplantation should be screened for cholelithiasis. The presence of symptoms should not be required before recommending operative intervention. (Arch Surg. 1991;126:571-573) References 1. Spes CH, Angermann CE, Beyer RW, et al. Increased incidence of cholelithiasis in heart transplant recipients receiving cyclosporine therapy . J Heart Transplant . 1990;9:404-407. 2. Shade RR, Guglieimi A, Van Thiel DH, et al. Cholestasis in heart transplant recipients treated with cyclosporine . Transplant Proc . 1983;15:2757-2760. 3. Bortnichak EA, Freeman DH, Ostfeld AM, et al. The association between cholesterol cholelithiasis and coronary heart disease in Framingham, Massachusetts . Am J Epidemiol . 1985;121:19-30. 4. Leunissen KML, Teule J, Degenaar DP, Kho TL, Frenken LAM, Van Hoof JP. Impairment of liver synthetic function and decreased liver flow during cyclosporine A therapy . Transplant Proc . 1987;19:1822-1824. 5. LeThai B, Dumont M, Michel A, Erlinger S, Houssin D. Cyclosporine-induced cholestases: inhibition of bile acid secretion is caused by the parental molecule . Transplant Proc . 1987;19:4149-4151. 6. Aziz S, Bergdahl L, Baldwin JC, et al. Pancreatitis after cardiac and cardiopulmonary transplantation . Surgery . 1985;97:653-661. 7. DiSesa VA, Kirkman RL, Tilney NL, Mudge GH, Collins JJ, Cohn LH. Management of general surgical complications following cardiac transplantation . Arch Surg . 1989;124:539-541.Crossref 8. Colon R, Frazier OH, Kahan BD, et al. Complications in cardiac transplant patients requiring general surgery . Surgery . 1988;103:32-38. 9. Steed DL, Brown B, Reilly JJ, et al. General surgical complications in heart and heart-lung transplantation . Surgery. 1985;98:739-745. 10. Kirklin JK, Holm A, Aldrete JS, White C, Bourge RC. Gastrointestinal complications after cardiac transplantation: potential benefit of early diagnosis and prompt surgical intervention . Ann Surg . 1990;221:538-542.Crossref 11. Villar HV, Neal DD, Levinson M, et al. Gastrointestinal complications after human transplantation and mechanical heart replacement . Am J Surg . 1989;157:168-173.Crossref 12. Girardet RE, Rosenbloom P, DeWeese BM, et al. Significance of asymptomatic biliary tract disease in heart transplant recipients . J Heart Transplant . 1989;8:391-399.
Archives of Surgery – American Medical Association
Published: May 1, 1991