Nephrol Dial Transplant. 2007; published online ahead of print

The incidence of gallstone disease in patients on a kidney transplantation waiting list is similar to that of the general population, but in transplant patients, the complications may be severe, researchers in Finland report. They recommend screening and treatment of pre- and post-transplantation gallstone disease.

Leena Halme, MD, of the Helsinki University Hospital, and her colleagues evaluated complications of gallstone disease in 1,608 kidney transplantation patients (median age, 45.5 years) on cyclosporine and long-term steroid treatment. The patients received their kidneys between 1990 and 2000. Dr. Halme’s group performed abdominal ultrasound examinations on a subgroup of 304 patients to evaluate the prevalence of cholecystolithiasis after kidney transplantation and correlated the findings with serum lipid values, changes in BMI, and use of statins.

Of the 1,608 subjects, 102 (6.3%) had gallstones diagnosed prior to transplantation and 165 (10%) had gallstones diagnosed after transplantation. Pre-transplant cholecystectomy due to cholecystolithiasis—a prerequisite for acceptance to the renal transplant waiting list—had been performed on 71 (4%) of the patients. Biliary complications developed in 30 (15%) patients with diagnosed post-transplant gallstones and four without gallstones. The researchers identified 25 cases of cholecystitis, of which three resulted in gallbladder perforations. Seventeen patients (50%) with biliary complications required urgent surgery and one (3%) patient died of postoperative complications.

In the subgroup of ultrasound examination patients, who had a median seven years follow-up after transplantation, 81% had no gallstones, 10% and 9% had gallstones diagnosed before and after transplantation, respectively.