Silent gallbladder stone in kidney transplantation recipients: should it be treated? a retrospective cohort study

Myeong Hwan Lee; Yunyoung Jang; Eunjeong Kang; Yong Chul Kim; Sang Min Il; Sang Hyub Lee; In Rae Cho; Woo Hyun Paik; Hajeong Lee

doi:10.1097/JS9.0000000000001394

Silent gallbladder stone in kidney transplantation recipients: should it be treated? a retrospective cohort study

Int J Surg. 2024 Apr 3. doi: 10.1097/JS9.0000000000001394. Online ahead of print.

Authors

Myeong Hwan Lee¹, Yunyoung Jang², Eunjeong Kang², Yong Chul Kim², Sang Min Il³, Sang Hyub Lee¹, In Rae Cho¹, Woo Hyun Paik¹, Hajeong Lee²

Affiliations

¹ Division of Gastroenterology.
² Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
³ Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

PMID: 38573083
DOI: 10.1097/JS9.0000000000001394

Abstract

Background: Treatment and follow-up strategies for silent gallbladder stones in patients before kidney transplantation (KT) remain unknown. Therefore, we aimed to elucidate the role of pre-KT cholecystectomy in preventing biliary and surgical complications.

Materials and methods: This study retrospectively analyzed 2,295 KT recipients and 3,443 patients waiting for KT at a single tertiary center from January 2005 to July 2022. The primary outcomes were the incidences of biliary and post-cholecystectomy complications in KT recipients. Firth's logistic regression model was used to assess the risk factors for biliary complications.

Results: Overall, 543 patients awaiting KT and 230 KT recipients were found to have biliary stones. Among the KT recipients, 16 (7%) underwent cholecystectomy before KT, while others chose to observe their biliary stones. Pre-KT cholecystectomy patients did not experience any biliary complications, and 20 (9.3%) patients who chose to observe their stones experienced complications. Those who underwent cholecystectomy before KT developed fewer post-cholecystectomy complications (6.3%) compared with those who underwent cholecystectomy after KT (38.8%, P=0.042), including reduced occurrences of fatal postoperative complications based on the Clavien-Dindo classification. Multiple stones (odds ratio [OR], 3.09; 95% confidence interval [CI], 1.07-8.90; P=0.036), thickening of the gallbladder wall (OR, 5.39; 95% CI, 1.65-17.63; P=0.005), and gallstones>1 cm in size (OR 5.12, 95% CI: 1.92-13.69, P=0.001) were independent risk factors for biliary complications. Among patients awaiting KT, 23 (4.2%) underwent cholecystectomy during the follow-up, resulting in one post-cholecystectomy complication.

Conclusion: Gallstone-related biliary complications following KT and subsequent cholecystectomy was associated with more serious complications and worse treatment outcomes. Therefore, when KT candidates had risk factor for biliary complications, preemptive cholecystectomy for asymptomatic cholecystolithiasis could be considered to reduce further surgical risk.