Cholecystectomy is one of the most common general surgical procedures. Given the need for lifelong immunosuppression and the physiologic impact of years of renal replacement, we hypothesized that cholecystectomy might have higher risks for KTR. We investigated the differences in morbidity, LOS, and cost between KTR and non-KTR undergoing cholecystectomy at both transplant and non-transplant centers nationwide.

METHODS: The National Inpatient Sample was used to study 7318 adult KTR and 5.3 million non-KTR who underwent cholecystectomy between 2000-11. Morbidity, defined as postoperative complications, was identified by ICD9 code. Complication rates, LOS, and cost were compared using hierarchical logistic regression, hierarchical negative binomial regression, and mixed effects log-linear models respectively.

RESULTS: The mortality rate among KTR was higher than for non-KTR (2.7 vs 1.2%, p <0.001; adjusted OR 2.39, 95%CI 1.66-3.44). Morbidity was also higher (18.8 vs 13.9%, p <0.001; adjusted OR 1.30, 95%CI 1.12-1.51)(Table 1;2). LOS was longer (5 vs 3 days, p <0.001; adjusted ratio 1.23, 95% 1.18-1.28) and hospital costs were higher in KTR compared to non-KTR ($12077 vs $9002, p<0.001; adjusted ratio 1.14, 95%CI 1.10-1.18). These findings were similar at both transplant center and non-transplant centers.

CONCLUSION: KTR have higher mortality, greater morbidity, longer LOS, and higher cost than non-KTR undergoing cholecystectomy. Undergoing surgery at a transplant center does not attenuate these findings. Physicians should consider these elevated risks when planning for surgery in the KTR population and counsel patients accordingly.

CITATION INFORMATION: DiBrito S, Holscher C, Olorundare I, Haugen C, Alimi Y, Segev D, Garonzik-Wang J. Outcomes Following Cholecystectomy in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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