Management of biliary tract disease in heart and lung transplant patients

Gupta, Dipin; Sakorafas, George H.; McGregor, Christopher G.A.; Harmsen, William S.; Farnell, Michael B.

doi:10.1067/msy.2000.108210

Cited by 32 publications

(23 citation statements)

References 12 publications

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“…They were carried out in ten different countries, particularly in Europe ( n = 11) [13, 14, 18, 24, 28–30, 34, 35, 38, 40], North America ( n = 24) [2, 4, 11, 12, 15–17, 19, 21–23, 25–27, 31, 33, 36, 37, 39, 41, 43–46], Asia and Pacific ( n = 4) [20, 32, 42, 47]. The overall number of transplanted patients considered was 71671.…”

Section: Resultsmentioning

confidence: 99%

Emergency abdominal surgery after solid organ transplantation: a systematic review

et al. 2016

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AimsDue to the increasing number of solid organs transplantations, emergency abdominal surgery in transplanted patients is becoming a relevant challenge for the general surgeon. The aim of this systematic review of the literature is to analyze morbidity and mortality of emergency abdominal surgery performed in transplanted patients for graft-unrelated surgical problems.MethodsThe literature search was performed on online databases with the time limit 1990–2015. Studies describing all types of emergency abdominal surgery in solid organ transplanted patients were retrieved for evaluation.ResultsThirty-nine case series published between 1996 and 2015 met the inclusion criteria and were selected for the systematic review. Overall, they included 71671 transplanted patients, of which 1761 (2.5 %) underwent emergency abdominal surgery. The transplanted organs were the heart in 65.8 % of patients, the lung in 22.1 %, the kidney in 9.5 %, and the liver in 2.6 %. The mean patients’ age at the time of the emergency abdominal surgery was 49.4 ± 7.4 years, and the median time from transplantation to emergency surgery was 2.4 years (range 0.1–20). Indications for emergency abdominal surgery were: gallbladder diseases (80.3 %), gastrointestinal perforations (9.2 %), complicated diverticulitis (6.2 %), small bowel obstructions (2 %), and appendicitis (2 %). The overall mortality was 5.5 % (range 0–17.5 %). The morbidity rate varied from 13.6 % for gallbladder diseases to 32.7 % for complicated diverticulitis. Most of the time, the immunosuppressive therapy was maintained unmodified postoperatively.ConclusionsEmergency abdominal surgery in transplanted patients is not a rare event. Although associated with relevant mortality and morbidity, a prompt and appropriate surgery can lead to satisfactory results if performed taking into account the patient’s immunosuppression therapy and hemodynamic stability.

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Section: Resultsmentioning

confidence: 99%

Emergency abdominal surgery after solid organ transplantation: a systematic review

et al. 2016

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“…Prophylactic cholecystectomy can be performed either during the pretransplant period or-when appropriate-at the time of transplantation. The theoretical basis for this recommendation is that these patients are more likely to become symptomatic, especially in the first 2 years after transplantation [73]. Moreover, because of immunosuppression, diagnosis of complications of cholelithiasis may be more difficult; these complications are associated with increased morbidity and mortality.…”

Section: Transplantationmentioning

confidence: 94%

“…Moreover, because of immunosuppression, diagnosis of complications of cholelithiasis may be more difficult; these complications are associated with increased morbidity and mortality. The aim of prophylactic cholecystectomy is to remove of a possible septic focus that carries a high potential for severe complications in immunosuppressed patients [72,73]. The mortality rate associated with emergency cholecystectomy in patients who have received a heart transplant is high, up to 36% in the review by Begos et al [74].…”

Section: Transplantationmentioning

confidence: 98%

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Asymptomatic Cholelithiasis: Is Cholecystectomy Really Needed? A Critical Reappraisal 15 Years After the Introduction of Laparoscopic Cholecystectomy

Sakorafas¹,

Milingos²,

Peros³

2007

Dig Dis Sci

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198

129

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Asymptomatic cholelithiasis is increasingly diagnosed today, mainly as a result of the widespread use of abdominal ultrasonography for the evaluation of patients for unrelated or vague abdominal complaints. About 10-20% of people in most western countries have gallstones, and among them 50-70% are asymptomatic at the time of diagnosis. Asymptomatic gallstone disease has a benign natural course; the progression of asymptomatic to symptomatic disease is relatively low, ranging from 10-25%. The majority of patients rarely develop gallstone-related complications without first having at least one episode of biliary pain ("colic"). In the prelaparoscopy era, (open) cholecystectomy was generally performed for symptomatic disease. The minimally invasive laparoscopic cholecystectomy refueled the discussion about the optimal management of asymptomatic cholelithiasis. Despite some controversy, most authors agree that the vast majority of subjects should be managed by observation alone (expectant management). Selective cholecystectomy is indicated in defined subgroups of subjects, with an increased risk for the development of gallstone-related symptoms and complications. Concomitant cholecystectomy is a reasonable option for good-risk patients with asymptomatic cholelithiasis undergoing abdominal surgery for unrelated conditions. Routine cholecystectomy for all subjects with silent gallstones is a too aggressive management option, not indicated for most subjects with asymptomatic cholelithiasis. An in-depth knowledge of the natural history of gallstone disease is required to select the optimal management option for the individual subject with silent gallstones. Management options should be extensively discussed with the patient; he or she should be actively involved in the process of therapeutic decision making.

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“…Cholecystectomy after transplantation is usually performed in emergency conditions and it presents a high mortality rate [43]. In a study of heart, lung or lung-heart transplanted patients, 37% were diagnosed with biliary disorders which consisted of gallbladder wall thickening, sludge in the gallbladder with distended bile ducts, gallbladder hydrops, or bile duct stones [43], with high mortality rates following surgery. The etiology of the pancreatobiliary disorders after transplantation is multifactorial; therapy with CyA is associated with a higher incidence of gallstones [44] due to cholestasis and reduced bile transit.…”

Section: Diseases Of the Biliary Tractmentioning

confidence: 99%

Gastrointestinal Side Effects of Post-Transplant Therapy

Lucan

Berardinelli

2016

JGLD

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Modern immunosuppressive therapy has produced a real revolution in renal and organ transplantation but it comes with the price of multiple side effects. There are many gastrointestinal (GI) complications that are the consequence of transplant immunosuppressant medication. In fact, for any immunosuppressant therapy, certain standardized precepts and attitudes that aim to reduce the incidence and the impact of the medication side effects must be applied. Many patients undergo renal transplantation and the physicians have to be aware of the advantages and the risks associated. This article reviews the main GI complications that may arise as a consequence of immunosuppressive therapy after solid organ transplantation, focusing on renal and renal/pancreas transplantation, as well as the ways in which the incidence of these complications can be reduced. Management of the post-transplant therapy is mandatory in order to increase not only the grafts’ and the patients’ survival, but also their quality of life by the occurrence of fewer complications. Abbreviations: Aza: azathioprine; CMV: cytomegalovirus; CsA: cyclosporine A; GI: gastrointestinal; MMF: mycophenolate mofetil; NSAID: non-steroidal anti-inflammatory drugs; Tac: tacrolimus.

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Management of biliary tract disease in heart and lung transplant patients

Cited by 32 publications

References 12 publications

Emergency abdominal surgery after solid organ transplantation: a systematic review

Emergency abdominal surgery after solid organ transplantation: a systematic review

Asymptomatic Cholelithiasis: Is Cholecystectomy Really Needed? A Critical Reappraisal 15 Years After the Introduction of Laparoscopic Cholecystectomy

Gastrointestinal Side Effects of Post-Transplant Therapy

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