Ercp In The Liver Transplant Population: Is It Safe?

INTRODUCTION: Biliary complications are commonly seen following liver transplantation. These biliary complications include anastomotic strictures, ischemia induced biliary lesions, cholangitis and bile duct stones. Endoscopic retrograde cholangiopancreatography (ERCP) can be used to treat these common post-transplant complications. We sought to evaluate outcomes and complications of ERCP in the liver transplant population. METHODS: The study population was derived from the HCUP-National Inpatient Sampling database for the years 2010 to 2015. ICD-9 codes were used to identify all patients with a history of liver transplantation who underwent ERCP. Our primary outcomes were in-hospital all-cause mortality, total cost of hospitalization and mean length of stay. We also evaluated rates of post-ERCP pancreatitis and perforation. Propensity score matching was used to adjust for baseline confounders. RESULTS: Out of a total of 155,478 patients undergoing ERCP, 1,224 (0.8%) had history of liver transplantation. Transplanted patients were younger, with higher rates of CKD, hepatitis, diabetes, alcohol and tobacco use. All-cause mortality (2.4% vs 0.4%, P < 0.0001) and post-ERCP pancreatitis (13.6% vs 2.8%, P < 0.0001) were less frequent in the liver transplant population, while perforations were more common (0.4% vs 0.8%). Length of stay (8.1 ± 9.7 vs 7.8 ± 9.1, P = 0.391) and cost of hospitalization ($76,881 ± 109,303 vs $80,240 ± 102,118, P = 0.291) were similar between the two groups (Table 2). After propensity score matching analysis, the statistically significant differences in all-cause mortality, cost of hospitalization and post-ERCP pancreatitis remained. Perforation rates were similar between the two groups (0.4% vs 0.8%, P = 0.301) whereas transplanted patients had shorter length of stay (8.9 ± 9.5 vs 7.8 ± 9.1, P = 0.005) (Table 2). CONCLUSION: ERCP in liver transplant recipients is associated with lower rates of all-cause mortality and post-ERCP pancreatitis compared to the general population. There is no difference in perforation rates and cost of hospitalization. Post-ERCP mortality in liver transplant recipients is a rare complication.Table 1Table 2