Effect of ERCP Utilization and Biliary Complications on Post-Liver-Transplantation Mortality and Graft Survival

Biliary complications after liver transplant are a frequent source of morbidity. However, little recent mortality data exists related to endoscopic management of these complications. To determine the effect of endoscopic retrograde cholangiopancreatography (ERCP) utilization and biliary complications on patient and graft survival after liver transplantation. This study was a retrospective cohort study at the University of North Carolina Hospitals from 2004 to 2007. One hundred thirty-two consecutive liver transplant patients were included. Recipient, donor, and clinical data were extracted from electronic resources. The main outcome measurements were all-cause mortality and graft failure. Of 132 transplants, 59 (45%) required ERCP post transplant, and 49 (37%) were found to have a biliary complication by ERCP. The 1-year patient survival for those treated by ERCP with a biliary complication was 90% compared with 81% in those without a biliary complication [P = 0.018; unadjusted hazard ratio (HR) = 0.32; 95% confidence interval (CI) 0.11-0.93]. The 1-year graft survival in those with and without a biliary complication was 94% and 73%, respectively (P < 0.001; unadjusted HR 0.19; 95% CI 0.07-0.56). This effect on patient and graft survival persisted after multivariate analysis. Similar results were seen for ERCP utilization alone, and when early deaths within the first 30 days were excluded. Patients who underwent ERCP for a biliary complication post liver transplantation had better overall and graft survival than patients who did not have an ERCP. Biliary complications and ERCP utilization are common after liver transplant, but they do not confer excess mortality.