Gallstone formation after pancreas and/or kidney transplantation: an analysis of risk factors

Incidence and Mortality of Emergency General Surgery Conditions Among Solid Organ Transplant Recipients in Ontario, Canada: A Population-based Analysis

BACKGROUND

Emergency general surgery (EGS) conditions and their outcomes are perceived to be disproportionately high among solid organ transplant recipients (SOTRs). However, this has not been adequately investigated at a population level. We characterized the incidence and mortality of EGS conditions among SOTRs compared with nontransplant patients.

METHODS

Data were collected through linked administrative population-based databases in Ontario, Canada. We included all adult SOTRs (kidney, liver, heart, and lung) who underwent transplantation between 2002 and 2017. We then identified posttransplantation emergency department visits for EGS conditions (appendicitis, cholecystitis, choledocolithiasis, perforated diverticulitis, incarcerated/strangulated hernias, small bowel obstruction, and perforated peptic ulcer). Age-, sex-, and year-standardized incidence rate ratios (SIRRs) were generated. Logistic regression models were used to evaluate association between transplantation status and 30 d mortality after adjusting for demographics, year, and comorbidities.

RESULTS

Ten thousand seventy-three SOTRs and 12 608 135 persons were analyzed. SOTRs developed 881 EGS conditions (non-SOTRs: 552 194 events). The incidence of all EGS conditions among SOTR was significantly higher compared with the nontransplant patients [SIRR 3.56 (95% confidence interval [CI] 3.32-3.82)], even among those with high Aggregated Diagnosis Groups scores ( > 10) [SIRR 2.76 (95% CI 2.53-3.00)]. SOTRs were 1.4 times more likely to die at 30 d [adjusted odds ratio 1.44 (95% CI 1.08-1.91)] after an EGS event compared with nontransplant patients, predominantly amongst lung transplant recipients [adjusted odds ratio 3.28 (95% CI 1.72-6.24)].

CONCLUSIONS

The incidence of EGS conditions is significantly higher in SOTRs even after stratifying by comorbidity burden. This is of particular importance as SOTRs also have a higher likelihood of death after an EGS condition, especially lung transplant recipients.

Kidney and pancreas transplant recipients undergoing cholecystectomy experience superior outcomes in transplant centers

BACKGROUND

This retrospective analysis aims to identify differences in surgical outcomes between pancreas and/or kidney transplant recipients and the general population undergoing cholecystectomy.

METHODS

Multivariate logistic regression and linear regression tests computed odds ratios (OR) and coefficients of the linear regression by analyzing weighted data from the NIS database between 2005 and 2014 to identify differences in mortality, morbidity, length of stay (LOS) and costs amongst KTx, PTx, PKTx, and non-Tx undergoing cholecystectomy in all centers and transplant centers.

RESULTS

Overall 6007 KTx, 164 PTx, 535 PKTx, and 4,207,241 non-Tx met the inclusion criteria. Mortality from cholecystectomy was 1.0%. Transplant recipients did not experience a significant increase in mortality. However KTx and PTx suffered increased morbidity risks (KTx OR1.244 p < 0.01; PTx OR2.165 p < 0.01) compared to non-Tx. However transplant recipients did not incur an increased morbidity risk in transplant centers.

CONCLUSION

Transplant recipients undergoing cholecystectomy should be counseled about their increased complication risks. Surgeons should consider transferring KTx and PTx to transplant centers for their cholecystectomy procedure to mitigate these risks.

Gallbladder Pathologies in Kidney Transplant Recipients: Single-Center Experience and a Review of the Literature

Background

In patients with end-stage renal disease, cholelithiasis is observed with an increased frequency. In transplant recipients, symptoms might be obscured, which may delay the diagnosis and lead to complications. The aim of our study was to evaluate the frequency of gallbladder pathologies in kidney transplant recipients (KTRs) in the Caucasian population, and to discuss the potential benefits of prophylactic cholecystectomy before kidney transplantation (KT).

Material/Methods

Data from 434 patients who underwent KT was analyzed. Demographic data along with gallbladder status were collected from the pre-transplantation charts. We compared our results to data from the general Polish population.

Results

In our analyzed group of KTRs, there were 284 men and 150 women. Complete data, including abdominal ultrasound description, were available in 412 cases. In this group, 36 patients (8.74%) underwent cholecystectomy before KT. Other gallbladder pathologies (gallstones and polyps) were found in 41 patients (9.95%) at pre-transplantation evaluation. The incidence of gallbladder pathologies in KTRs, being mostly cholelithiasis, was higher than in the general Polish population.

Conclusions

In specific age subgroups of KTRs, the frequency of gallbladder pathologies was higher than in the general population. Prophylactic cholecystectomy may potentially offer benefits in these subgroups of patients.

Immunosuppressants and new onset gallstone disease in patients having undergone renal transplantation

BACKGROUND

There are very few reports describing the development of gallstone disease after renal transplantation (GSDART) in Asia. The aim of this population-based study was to explore the prevalence, predictive factors, and outcomes of newly developed GSDART. The relationship between immunosuppressant and GSDART was also explored.

PATIENTS AND METHODS

Renal transplantation (RT) recipients were identified from the National Health Insurance Research Database of Taiwan during January 1998-December 2012. In total, 2,630 adult patients, who had neither been diagnosed with gallstone disease (GSD) nor undergone cholecystectomy, were included in this study. These patients underwent follow-up till the diagnosis of GSDART was established. Risk factors and post-RT immunosuppressant treatments were investigated and analyzed using Cox regression analysis. The cumulative mortality in patients with and without GSDART was also evaluated.

RESULTS

The final dataset comprised 143 patients who developed GSDART and 2,487 patients who had not been diagnosed with GSDART during the follow-up period. The prevalence of GSDART was 5.4%. On performing univariate analysis, age (p=0.0276) and certain immunosuppressant administrations were identified as significant risk factors for GSDART. After adjusting for age, multivariable analysis showed that everolimus (adjusted hazard ratio 0.287, p=0.0013) was independently associated with the development of GSDART. The overall mortality rate (6.99%, p=0.0341) was significantly decreased in the GSDART group.

CONCLUSION

Increased age was the most consistent risk factor for GSD, and everolimus-based immunotherapy indicated a decreased incidence of GSDART in RT recipients. The long-term mortality rate was significantly decreased in patients with GSDART.

Hepatic manifestations of non-steroidal inflammatory bowel disease therapy

Inflammatory bowel disease (IBD) is composed of Crohn’s disease and ulcerative colitis and is manifested by both bowel-related and extraintestinal manifestations. Recently the number of therapeutic options available to treat IBD has dramatically increased, with each new medication having its own mechanism of action and side effect profile. A complete understanding of the hepatotoxicity of these medications is important in order to distinguish these complications from the hepatic manifestations of IBD. This review seeks to evaluate the hepatobiliary complications of non-steroid based IBD medications and aide providers in the recognition and management of these side-effects.

Surgical procedures not connected with transplantation in patients after kidney or kidney and pancreas transplant with stable function of graft

The aim of the study was to evaluate complication during and after surgical procedure without connection with transplantation among patients after kidney, kidney and pancreas transplantation with stable function of graft.

MATERIAL AND METHODS

54 patients underwent 62 surgical procedures without connection with transplantation procedure. Main characteristic: standard immunosuppressive treatment, main age 51.1±13.95 years, men 77.4%, hospitalization time 5.27±3.31 day, group 1 - 55 procedures among patients after kidney transplantation, group 2 - 7 procedure among patients after kidney and pancreas transplantation.

RESULTS

Procedures from general surgery comprised 60% [cholecystectomy 19 (51%), left hemicolectomy 1 (3%), esophagus removal 1 (3%), hernia repair 8 (22%), nefrectomy 3 (8%), pancreas transplantation in patients with functional renal graft 1 (3%), laparotomy 4 (11%), vascular surgery 27% (correction of arteriovenosus fistula 13 (76%), by-pass surgery 1 (6%), embolectomy 1 (6%), implantation of aortal - iliac stentgraft 1 (6%), surgery of iliac artery 1 (6%)]. There has been no difference between parameters measured before and after procedure: creatinine (p=0.93), GFR (p=0.07), urea (p=0.25), glycaemia (p=0.322), glycated hemoglobin (p=0.3), C-peptide (p=0.3). In both groups were no differences in levels of creatinine (p=0.78) and urea (p=0.23), measured in the next years after surgical procedure. Mortality 0%, lost of graft 0%, in - hospital morbidity 10 (16.2%) (hematoma 1.6%, endocavitary electrode 1.6%, wound healing defect 16.2%). Morbidity in group 1 - 12.7%, group 2 - 48.8%, p=0.04.

CONCLUSIONS

Surgical procedures performed in a specialist center do not impaire prognosis of patients with stable function of graft, after kidney, kidney and pancreas transplantation.