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

Massively distended, necrotic and hemorrhagic gallbladder in a long-term octreotide-treated patient with added everolimus

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Somatostatin analogs and immunosuppressants promote gallstones formation.

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Severe cholecystitis can develop during long-term treatment of metastatic carcinoid cancer.

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There is no proof that severe cholecystitis is caused by somatostatin analogs and immunosuppressants.

Introduction

Long-term treatment with somatostatin analogs, such as octreotide, is well known to promote gallstones formation. Immunosuppressive therapy in renal transplantation is also associated with increased occurrence of gallstones. But acute cholecystitis develops only in a few cholelithiasis patients. However, it is not known whether long-term somatostatin analog therapy and immunosuppressants aggravate the severity of disease if the patient develops cholecystitis.

Case presentation

We present a case of severe cholecystitis in a patient with metastatic carcinoid cancer on octreotide long-acting release therapy for seven years with newly added immunosuppressant, everolimus.

Discussion

Cholelithiasis as well as cholecystitis develop more often in patients on somatostatin analogs and immunosuppressants than in general population. However, morbidity remains negligible.

Conclusion

No conclusion can be drawn on the contribution of somatostatin analogs and immunosuppressant in the occurrence of severe cholecystitis. Prophylactic cholecystectomy is not indicated in patients with this medication.

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.