背景:肾移植(KT)前患者无症状胆囊结石的治疗和随访策略尚不清楚。因此,我们旨在阐明KT胆囊切除术前在预防胆道和手术并发症方面的作用.
方法:本研究回顾性分析了2005年1月至2022年7月在单个三级中心等待KT的2,295名KT接受者和3,443名患者。主要结果是KT受者胆道和胆囊切除术后并发症的发生率。采用FirthLogistic回归模型评估胆道并发症的危险因素。
结果:总体而言,543名等待KT的患者和230名KT接受者被发现患有胆道结石。在KT收件人中,16例(7%)在KT前接受了胆囊切除术,而其他人则选择观察他们的胆道结石。KT胆囊切除术前患者未出现任何胆道并发症,20例(9.3%)选择观察结石的患者出现并发症.与KT后接受胆囊切除术的患者相比,KT前接受胆囊切除术的患者发生的胆囊切除术后并发症较少(6.3%)(38.8%,P=0.042),包括根据Clavien-Dindo分类减少致命的术后并发症。多颗结石(赔率比[OR],3.09;95%置信区间[CI],1.07-8.90;P=0.036),胆囊壁增厚(OR,5.39;95%CI,1.65-17.63;P=0.005),胆结石>1cm(OR5.12,95%CI:1.92-13.69,P=0.001)是胆道并发症的独立危险因素。在等待KT的患者中,随访期间23例(4.2%)行胆囊切除术,导致一次胆囊切除术后并发症。
结论:KT和随后的胆囊切除术后胆结石相关的胆道并发症与更严重的并发症和更差的治疗结果相关。因此,当KT候选人有胆道并发症的危险因素时,对于无症状胆囊结石症,可考虑先发制人胆囊切除术以降低进一步手术风险.
BACKGROUND: Treatment and follow-up strategies for silent gallbladder stones in patients before kidney transplantation (KT) remain unknown. Therefore, the authors aimed to elucidate the role of pre-KT
cholecystectomy in preventing biliary and surgical complications.
METHODS: This
study retrospectively analyzed 2295 KT recipients and 3443 patients waiting for KT at a single tertiary center from January 2005 to July 2022. The primary outcomes were the incidences of biliary and postcholecystectomy 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 postcholecystectomy 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% 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 postcholecystectomy complication.
CONCLUSIONS: 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, pre-emptive
cholecystectomy for asymptomatic cholecystolithiasis could be considered to reduce further surgical risk.