Cholelithiasis in pancreas and kidney transplant recipients with diabetes

Jeffrey A. Lowell, Robert J. Stratta, Rodney J. Taylor, J. Stevenson Bynon, Jennifer Lynn Larsen, Nick L. Nelson

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background. Vascularized pancreas transplantation (PTx) for type I diabetes mellitus results in euglycemia at the expense of chronic immunosuppression, hyperinsulinemia, and dyslipidemia. However, the effect of PTx on native biliary lithogenesis remains unknown. Methods. To address this issue, we retrospectively studied 72 consecutive pancreas transplant recipients and compared them with patients both with (n = 35) and without (n = 52) diabetes mellitus undergoing kidney transplantation alone (KTA). All patients underwent pretransplantation abdominal ultrasonography, which was repeated at 6- to 12-month intervals after transplantation. PTx recipients were managed with quadruple immunosuppression with OKT3 induction. Kidney transplant recipients received cyclosporine and prednisone. Results. Seventeen (30.4%) of 56 evaluable PTx recipients had gallstones at a mean interval of 13 months (range, 5 to 24) after PTx. Eleven patients underwent open cholecystectomy (with one surgical exploration of common bile duct for choledocholithiasis), three underwent laparoscopic cholecystectomy, and the other three are being managed expectantly. Gallstone analysis revealed predominantly cholesterol stones. The incidence of cholelithiasis in kidney transplant recipients with and without diabetes mellitus was 27.3% and 12.2%, respectively (p = 0.04). Conclusions. Pancreas transplant and kidney transplant recipients with diabetes are predisposed to the development of gallstones compared with recipients without diabetes. An interaction between diabetes mellitus-induced gallbladder dysmotility and cyclosporine-induced cholestasis may be a possible mechanism. We recommend serial ultrasonographic examinations in pancreas transplant and kidney transplant recipients, and cholecystectomy in pancreas transplant recipients with cholelithiasis should be considered.

Original languageEnglish (US)
Pages (from-to)858-864
Number of pages7
JournalSurgery
Volume114
Issue number4
StatePublished - Oct 1993

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Cholelithiasis
Pancreas
Kidney
Gallstones
Diabetes Mellitus
Cholecystectomy
Immunosuppression
Cyclosporine
Transplants
Choledocholithiasis
Muromonab-CD3
Pancreas Transplantation
Laparoscopic Cholecystectomy
Cholestasis
Common Bile Duct
Hyperinsulinism
Dyslipidemias
Prednisone
Gallbladder
Type 1 Diabetes Mellitus

ASJC Scopus subject areas

  • Surgery

Cite this

Lowell, J. A., Stratta, R. J., Taylor, R. J., Bynon, J. S., Larsen, J. L., & Nelson, N. L. (1993). Cholelithiasis in pancreas and kidney transplant recipients with diabetes. Surgery, 114(4), 858-864.

Cholelithiasis in pancreas and kidney transplant recipients with diabetes. / Lowell, Jeffrey A.; Stratta, Robert J.; Taylor, Rodney J.; Bynon, J. Stevenson; Larsen, Jennifer Lynn; Nelson, Nick L.

In: Surgery, Vol. 114, No. 4, 10.1993, p. 858-864.

Research output: Contribution to journalArticle

Lowell, JA, Stratta, RJ, Taylor, RJ, Bynon, JS, Larsen, JL & Nelson, NL 1993, 'Cholelithiasis in pancreas and kidney transplant recipients with diabetes', Surgery, vol. 114, no. 4, pp. 858-864.
Lowell JA, Stratta RJ, Taylor RJ, Bynon JS, Larsen JL, Nelson NL. Cholelithiasis in pancreas and kidney transplant recipients with diabetes. Surgery. 1993 Oct;114(4):858-864.
Lowell, Jeffrey A. ; Stratta, Robert J. ; Taylor, Rodney J. ; Bynon, J. Stevenson ; Larsen, Jennifer Lynn ; Nelson, Nick L. / Cholelithiasis in pancreas and kidney transplant recipients with diabetes. In: Surgery. 1993 ; Vol. 114, No. 4. pp. 858-864.
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abstract = "Background. Vascularized pancreas transplantation (PTx) for type I diabetes mellitus results in euglycemia at the expense of chronic immunosuppression, hyperinsulinemia, and dyslipidemia. However, the effect of PTx on native biliary lithogenesis remains unknown. Methods. To address this issue, we retrospectively studied 72 consecutive pancreas transplant recipients and compared them with patients both with (n = 35) and without (n = 52) diabetes mellitus undergoing kidney transplantation alone (KTA). All patients underwent pretransplantation abdominal ultrasonography, which was repeated at 6- to 12-month intervals after transplantation. PTx recipients were managed with quadruple immunosuppression with OKT3 induction. Kidney transplant recipients received cyclosporine and prednisone. Results. Seventeen (30.4{\%}) of 56 evaluable PTx recipients had gallstones at a mean interval of 13 months (range, 5 to 24) after PTx. Eleven patients underwent open cholecystectomy (with one surgical exploration of common bile duct for choledocholithiasis), three underwent laparoscopic cholecystectomy, and the other three are being managed expectantly. Gallstone analysis revealed predominantly cholesterol stones. The incidence of cholelithiasis in kidney transplant recipients with and without diabetes mellitus was 27.3{\%} and 12.2{\%}, respectively (p = 0.04). Conclusions. Pancreas transplant and kidney transplant recipients with diabetes are predisposed to the development of gallstones compared with recipients without diabetes. An interaction between diabetes mellitus-induced gallbladder dysmotility and cyclosporine-induced cholestasis may be a possible mechanism. We recommend serial ultrasonographic examinations in pancreas transplant and kidney transplant recipients, and cholecystectomy in pancreas transplant recipients with cholelithiasis should be considered.",
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AB - Background. Vascularized pancreas transplantation (PTx) for type I diabetes mellitus results in euglycemia at the expense of chronic immunosuppression, hyperinsulinemia, and dyslipidemia. However, the effect of PTx on native biliary lithogenesis remains unknown. Methods. To address this issue, we retrospectively studied 72 consecutive pancreas transplant recipients and compared them with patients both with (n = 35) and without (n = 52) diabetes mellitus undergoing kidney transplantation alone (KTA). All patients underwent pretransplantation abdominal ultrasonography, which was repeated at 6- to 12-month intervals after transplantation. PTx recipients were managed with quadruple immunosuppression with OKT3 induction. Kidney transplant recipients received cyclosporine and prednisone. Results. Seventeen (30.4%) of 56 evaluable PTx recipients had gallstones at a mean interval of 13 months (range, 5 to 24) after PTx. Eleven patients underwent open cholecystectomy (with one surgical exploration of common bile duct for choledocholithiasis), three underwent laparoscopic cholecystectomy, and the other three are being managed expectantly. Gallstone analysis revealed predominantly cholesterol stones. The incidence of cholelithiasis in kidney transplant recipients with and without diabetes mellitus was 27.3% and 12.2%, respectively (p = 0.04). Conclusions. Pancreas transplant and kidney transplant recipients with diabetes are predisposed to the development of gallstones compared with recipients without diabetes. An interaction between diabetes mellitus-induced gallbladder dysmotility and cyclosporine-induced cholestasis may be a possible mechanism. We recommend serial ultrasonographic examinations in pancreas transplant and kidney transplant recipients, and cholecystectomy in pancreas transplant recipients with cholelithiasis should be considered.

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