Biliary surgery after cardiac transplantation
M. E. Sekela, D. A. Hutchins, J. B. Young and G. P. Noon
Department of Surgery, Baylor College of Medicine, Methodist Hospital, Houston, Tex.
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.
