Cholelithiasis in patients on the kidney transplant waiting list

Abstract

OBJECTIVESTo evaluate the prevalence of cholecystopathy in chronic renal patients awaiting kidney transplants.INTRODUCTIONThe prevalence and management of cholelithiasis in renal transplant patients is not well established.METHODSA total of 342 chronic renal failure patients on the waiting list for a kidney transplant were studied. Patients were evaluated for the presence of cholelithiasis and related symptoms, previous cholecystectomies and other abdominal surgeries, time on dialysis, and general data (gender, age, number of pregnancies, and body mass index).RESULTSCholelithiasis was found in 41 out of 342 patients (12%). Twelve of these patients, all symptomatic, had previously undergone cholecystectomies. Five out of 29 patients who had not undergone surgery were symptomatic. Overall, 17 patients (41.5%) were symptomatic. Their mean age was 54 (range 32–74) years old; 61% were female, and their mean body mass index was 25.4. Nineteen (76%) out of 25 women had previously been pregnant, with an average of 3.6 pregnancies per woman.CONCLUSIONSThe frequency of cholelithiasis was similar to that reported in the literature for the general population. However, the high frequency of symptomatic patients points toward an indication of routine pre-transplant cholecystectomy to avoid serious post-transplant complications.

End-stage renal disease is a risk factor for complex laparoscopic cholecystectomy in patients waiting for renal transplantation

“…[7] On these grounds, several authors advocate prophylactic cholecystectomy in asymptomatic patients before transplantation to elude serious morbidity and increased mortality, when diagnosis of gallstones is established. [468]…”

Aktualisierte S3-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) zur Prävention, Diagnostik und Behandlung von Gallensteinen

“…Zur Nierentransplantation existieren einzelne, nicht randomisierte Studien, deren Autoren eine prophylaktische Cholezystektomie wegen der möglichen zu erwartenden Komplikationen nach der Transplantation für sinnvoll erachten [687,688]. Prospektive Daten sowie Metaanalysen oder Reviews, auf deren Basis generell eine prophylaktische Cholezystektomie vor Nierentransplantation zu rechtfertigen wäre, existieren nicht.…”