Complications after ERCP in liver transplant recipients

Background: Complications of the biliary tract after liver transplantation are successfully managed with ERCP; however, the incidence and risk factors for post-ERCP complications remain unknown. Objective: To examine the incidence, risk factors, and short-term outcome of post-ERCP complications in liver transplant (LT) recipients. Design: Retrospective evaluation of all ERCPs performed in LT recipients at our institution during a 7-year, 4-month period. Setting: Tertiary referral center. Patients: A total of 243 ERCPs performed in 121 LT recipients with duct-to-duct anastomosis. Main Outcome Measurements: Incidence of post-ERCP complications. Predictive factors were determined by univariate and multivariate analyses. Results: Overall complications occurred in 22 procedures (9%) (13 mild, 9 moderate): pancreatitis in 9 patients (3.7%), cholangitis in 8 patients (3.3%), postsphincterotomy bleeding in 4 patients (1.6%), and subcapsular hematoma in 1 patient (0.4%). The mean hospitalization for post-ERCP complications was 4.8 days (range 2-11 days). Logistic regression identified mammalian target of rapamycin inhibitors (odds ratio [OR], 4.65; 95% CI, 1.01-21.81; P = .049), serum creatinine level greater than 2 mg/dL (OR, 4.17; 95% CI, 1.07-16.26; P = .04), biliary sphincterotomy (OR, 3.03; 95% CI, 1.07-8.53; P = .037), and more than 2 pancreatic duct contrast injections (OR, 2.95; 95% CI, 1.10-7.91; P = .032) as independent risk factors for post-ERCP complications, whereas steroid therapy (OR, 0.23; 95% CI, 0.08-0.63; P = .004) was an independent protective factor. Limitations: Single-center retrospective study. Conclusions: The rate of complications after ERCP in LT recipients seems to be similar to that of non-LT recipients. Complications in this analysis were more common in LT recipients receiving mammalian target of rapamycin inhibitors and those with renal failure, biliary sphincterotomy, and more than 2 pancreatic duct injections, whereas they were less common in those patients on steroid therapy. (Gastrointest Endosc 2011;74:285-94.)