Cholelithiasis in pediatric organ transplantation: Detection and management
Rainer Ganschow,
Rainer Ganschow
Department of Pediatrics, Pediatric Gastroenterology and Hepatology, University of Hamburg, Germany
Search for more papers by this authorRainer Ganschow,
Rainer Ganschow
Department of Pediatrics, Pediatric Gastroenterology and Hepatology, University of Hamburg, Germany
Search for more papers by this authorDr Rainer Ganschow, University of Hamburg, Department of Pediatrics, Pediatric Gastroenterology and Hepatology, Martinistraße 52, 20246 Hamburg, Germany
Tel.: +49-40-42803-4629
Fax: +49-40-42803-5311
E-mail: [email protected]
Abstract
Abstract: The real incidence and the underlying causes of cholelithiasis in pediatric solid organ recipients is probably not exactly known. In addition to well-established risk factors for cholelithiasis, children after heart, kidney, or liver transplantation may develop gallstones due to drug therapy, sepsis, parenteral nutrition, or surgical complications. For pediatric patients, data are very limited and heterogeneous. However, the incidence in pediatric heart recipients seems to be substantially higher compared with kidney or liver graft recipients. In this review article the present data are discussed focusing on incidence, detection, and management of cholelithiasis in pediatric organ transplantation. In general, surgery is the therapy of choice in symptomatic patients; however, the pharmacological profile of ursodeoxycholic acid and the first results on its clinical impact are promising. The value of prophylactic therapy with ursodeoxycholic acid must be determined in further studies.
References
- 1 Friesen CA, Roberts CC. Cholelithiasis: clinical characteristics in children. Clin Pediatr 1989: 7: 294–298.
- 2 Sears HF, Golden GT, Horsley JS. Cholecystitis in adolescents. Arch Surg 1973: 106: 651–653.
- 3
Holcomb Gw Jr,
Holcomb GW.
Cholelithiasis in infants, children and adolescents.
Pediatr Rev
1991: 11: 268–274.
10.1542/pir.11-9-268 Google Scholar
- 4 Schaffer EA, Small DM. Gallstone disease: pathogenesis and management. Curr Probl Surg 1976: 13: 1–72.
- 5 Kelly DA. Liver complications of pediatric parenteral nutrition – epidemiology. Nutrition 1998: 14: 153–157.
- 6 Ko CW, Sekijima JH, Lee SP. Biliary sludge. Ann Int Med 1999: 130: 301–311.
- 7 Duane WC. Formation of gallstones. In: Liver and Biliary Dis-ease, 2nd edn. Williams & Wilkins, Baltimore, Maryland, USA, 1996: 171–184.
- 8 Moseley RH. Bile secretion and cholestasis. In: Liver and Biliary Disease, 2nd edn. Williams & Wilkins, Baltimore, Maryland, USA, 1996: 185–204.
- 9 Glen F. 25 year experience in the surgical treatment of 5037 patients with non-malignant biliary tract disease. Surg Gynecol Obstet 1959: 109: 591–606.
- 10 Andrassy RJ, Treaddwill TA, Ratner IA, et al. Gallbladder dis-ease in children and adolescents. Am J Surg 1976: 132: 19–21.
- 11 Nicholas P, Rinaudo PA, Conn CO. Increased incidence of chole-lithiasis in Laennec's cirrhosis. Gastroenterology 1972: 62: 112–114.
- 12 Bonchier IAD. Postmortem study of the frequency of gallstones in patients with cirrhosis of the liver. Gut 1969: 10: 705–710.
- 13 Odievre M, Gautier M, Hadchouel M, et al. Severe familial intra-hepatic cholestasis. Arch Dis Child 1973: 48: 806–812.
- 14 King DR, Ginn-Pease ME, Lloyd TV, et al. Parenteral nutrition with associated cholelithiasis: another iatrogenic disease of in-fants and children. J Pediatr Surg 1987: 22: 593–596.
- 15 Murray FE, Stinchcombe SJ, Hawkey CJ. Development of biliary sludge in patients on intensive care unit: results of a prospective ultrasonographic study. Gut 1992: 33: 1123–1125.
- 16 Bolondi L, Gaiani S, Testa S, Labo G. Gallbladder sludge forma-tion during prolonged fasting after gastrointestinal tract surgery. Gut 1985: 26: 734–738.
- 17 Schaad UB, Suter S, Gianella-Barradovi A, et al. A comparison of ceftriaxone and cefuroxime for the treatment of bacterial men-ingitis in children. N Engl J Med 1990: 522: 141–147.
- 18 Lorber MI, Van Buren CT, Flechner SM, et al. Hepatobiliary and pancreatic complications of cyclosporine therapy in 466 renal transplant recipients. Transplantation 1987: 43: 35–40.
- 19 Ballantyne CM, Podet EJ, Patsch WP, et al. Effects of cyclo-sporine therapy on plasma lipoprotein levels. JAMA 1989: 262: 53–56.
- 20 Leunissen KML, Teule J, Degenaar TL, et al. Impairement of liver synthetic function and decreased flow during cyclosporine A therapy. Transplant Proc 1987: 19: 1822–1824.
- 21 Lorber MI, Van Buren CT, Flechner SM, et al. Hepatobiliary complications of cyclosporine therapy following renal transplantation. Transplant Proc 1987: 19: 1808–1810.
- 22 Begos DG, Franco KL, Baldwin JC, et al. Optimal timing and indications for cholecystectomy in cardiac transplant recipients. World J Surg 1995: 19: 661–667.
- 23 Menegaux F, Dorent R, Tabbi D, et al. Biliary surgery after heart transplantation. Am J Surg 1998: 175: 320–321.
- 24 Weinstein S, Lipsitz EC, Addonizio L, Stolar CJH. Cholelithiasis in pediatric cardiac transplant patients on cyclosporine. J Ped Surg 1995: 30: 61–64.
- 25 Peterseim DS, Pappas TN, Meyers CH, et al. Management of biliary complications after heart transplantation. J Heart Lung Transplant 1995: 14: 623–631.
- 26 Milas M, Ricketts RR, Amerson JR, Kanter K. Management of biliary tract stones in heart transplant patients. Ann Surg 1996: 223: 747–756.
- 27 Melvin WS, Meier DJ, Elkhammas EA, et al. Prophylactic chole-cystectomy is not indicated following renal transplantation. Am J Surg 1998: 175: 317–319.
- 28 Greenstein SM, Katz S, Sun S, et al. Prevalance of asymptomatic cholelithiasis and risk of acute cholecystitis after kidney trans-plantation. Transplantation 1997: 63: 1030–1031.
- 29 Pitre J, Dousset B, Massault PP, et al. Multiple intrahepatic stones caused by hemobilia in liver transplant recipients. Surgery 1997: 121: 352–354.
- 30 Cetta F, Montalto G, Zuckermann M, Cetta D. Hemobilia, infection, bile stasis, and intrahepatic stones in liver transplant recipients (letter). Surgery 1998: 123: 115–116.
- 31 Sheng RS, Ramirez CB, Zajko AB, Campbell WL. Biliary stones and sludge in liver transplant patients: a 13-year experience. Radiology 1996: 198: 243–247.
- 32 O'Connor TP, Lewis D, Jenkins RL. Biliary tract complications after liver transplantation. Arch Surg 1995: 130: 312–317.
- 33 Farouk M, Branum GD, Watters CR, et al. Bile compositional changes and cholesterol stone formation following orthotopic liver transplantation. Transplantation 1991: 52: 727–730.
- 34 Xu HS, Pilcher JA, Jones RS. Physiologic study of bile salt and lipid secretion in rats after liver transplantation. Ann Surg 1993: 217: 404–412.
- 35 Lowell JA, Stratta RJ, Taylor RJ, et al. Cholelithiasis in pan-creas and kidney transplant recipients with diabetes. Sugery 1993: 114: 858–863.
- 36 Filly RA, Allen B, Minton MJ, et al. In vitro investigation of the origin of echoes with biliary sludge. J Clin Ultrasound 1980: 8: 193–200.
- 37 Dahan P, Andant C, Levy P, et al. Prospective evaluation of endo-scopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholelithisasis in 45 patients with normal conventional ultrasonography. Gut 1996: 38: 277–281.
- 38 White DM, Correa RJ, Gibbons RP. Extracorporeal shock-wave lithotripsy for bile duct calculi. Am J Surg 1998: 175: 10–13.
- 39 Fromm H, Malavolti M. Dissolving gallstones. Adv Intern Med 1988: 33: 409–430.
- 40 Podda M, Zuin M, Battezzati PM, et al. Efficacy and safety of a combination of chenodeoxycholic acid and ursodeoxycholic acid for gallstone dissolution: a comparison with ursodeoxycholic adic alone. Gastroenterology 1989: 96: 222–229.
- 41 Oka H, Toda Y, Ikeda Y, et al. A multi-center double blind con-trolled trial of ursodeoxycholic acid for primary biliary cirrhosis. Gastroenterol Jpn 1990: 25: 774–780.
- 42
Sama C,
Morselli Labate AM,
Roda A, et al.
UDCA after liver transplantation.
J Hepatol
1990: 11 (Suppl. 2): S54.
10.1016/0168-8278(90)91550-G Google Scholar
- 43 Gutzler F, Fischer G, Sauer P, et al. Improved bioavailability of cyclosporin by coadmninistration of ursodeoxycholic acid. Gastroenterology 1992: 102: 816.
- 44
Soederdahl G,
Nowak G,
Duraj F, et al.
Ursodeoxycholic acid increased bile flow and effects bile composition in the early post-operative phase following liver transplantation.
Transplant Int
1998: 11 (Suppl. 1): S231–S238.
10.1111/j.1432-2277.1998.tb01121.x Google Scholar
- 45 Galle PR, Theilmann L, Raedsch R, et al. Ursodeoxycholate re-duces hepaottoxicity of bile salts in primary human hepatocytes. Hepatology 1990: 12: 486–491.
- 46 Heumann DM, Komito SF, Pandak WM, et al. Tauroursodeoxy-cholic acid protects angainst cholestatic and hepatocytolytic toxicity of more hydrophobic bile salts. Gastroenterology 1989: 96: A607.
- 47 Persson H, Friman S, Schersten T, et al. Ursodeoxycholic acid for prevention of acute rejection in liver transplant recipients (Letter). Lancet 1990: 336: 52–53.
- 48 Friman S, Persson H, Schersten T, et al. Adjuvant treat-ment with ursodeoxycholic acid reduces acute rejection after liver transplantation. Transplant Int 1992: 5 (Suppl. 1): S187–S189.
- 49 Barnes D, Talenti D, Cammell G, et al. A randomized clinical trial of ursodeoxycholic acid as adjuvant treatment to prevent liver transplant rejection. Hepatology 1997: 26: 853–857.
- 50 Keiding S, Hoeckerstedt K, Bjoero K, et al. The nordic multi-center double-blind randomized controlled trial of prophylactic ursodeoxycholic acid in liver transplant patients. Transplantation 1997: 63: 1591–1594.
- 51 Barbara L, Sama C, Venturoli N, et al. Bile acid therapy in gall-stones after liver transplantation. In: Cholestasis. Excerpta Medica. Elsevier Science, New York, NY, USA, 1994: 283–290.
- 52 Sitzmann JV, Pitt HA, Steinborn PA, Pasha ZR, Sanders RC. Cholecystokinin prevents parenteral nutrition induced biliara sludge in humans. Surg Gynecol Obstet 1990: 170: 25–31.
- 53 Lee SP, La Mont JT, Carey MC. Role of gallstone mucous hyper-secretion in the evolution of cholesterol gallstone: studies in a prairie dog. J Clin Invest 1981: 67: 1712–1223.
Citing Literature
