Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Complications After Orthotopic Liver Transplantation: Outcomes and Complications

Sanna, Claudia; Saracco, Giorgio Maria; Reggio, Dario; Moro, Fernando; Ricchiuti, A.; Strignano, Paolo; Mirabella, S.; Ciccone, Giovannino; Salizzoni, Mauro

doi:10.1016/j.transproceed.2009.03.086

Cited by 30 publications

(31 citation statements)

References 12 publications

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“…Studies assessing the role of diagnostic and therapeutic ERCP for biliary complications report an incidence of complications of 2% to 18%. [6][7][8][9][18][19][20][21][22][23][24][25][26][27][28][29][30] Living-donor recipients with biliary strictures present a higher rate of complications likely related to the technical difficulty of performing ERCP in these patients. 31,32 Therefore, previous disparity regarding the true rate of complications in LT recipients was most likely attributed to the lack of a proper analysis of this endpoint.…”

Section: Discussionmentioning

confidence: 99%

“…Published series of LT recipients who underwent ERCP for biliary complications indicate that the risks of bleeding, pancreatitis, and cholangitis, among other complications, after the procedure range between 2% and 18%. [6][7][8][9][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] However, these studies did not specifically evaluate the risk factors for complications after ERCP in this patient population. Additionally, there is a lack of information that identifies LT recipients at risk of complications after ERCP.…”

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confidence: 99%

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Complications after ERCP in liver transplant recipients

Balderramo

Bordas

Sendino

et al. 2011

Gastrointestinal Endoscopy

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Complications after ERCP in liver transplant recipients

Balderramo

Bordas

Sendino

et al. 2011

Gastrointestinal Endoscopy

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“…Because of these data, Ororio, et al were among the first to advocate nonoperative management of biliary complications through endoscopic and interventional radiographic approaches [12]. Since then, other authors have advocated frequent and aggressive use of endoscopic management of biliary complication [15-17], yet there have been few reports delineating the mortality related to biliary complications. Those reports that do include mortality data, such as those of Rizk et al and Pfau et al, cite no difference between biliary sources of mortality and other causes [18, 19].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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Background Biliary complications after liver transplant are a frequent source of morbidity. However, little recent mortality data exists related to endoscopic management of these complications. Aims To determine the effect of endoscopic retrograde cholangiopancreatography (ERCP) utilization and biliary complications on patient and graft survival after liver transplantation. Methods 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. Results 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. Conclusions 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.

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“…The motivation for the present study also stems from a previous pilot study26 where we found a lower rate of post-ERCP pancreatitis in our OLT recipients compared with the whole cohort of patients that underwent ERCP and a higher bleeding rate. Our study was planned with two main aims.…”

Section: Introductionmentioning

confidence: 94%

Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Patients with Post-Liver Transplant Biliary Complications: Results of a Cohort Study with Long-Term Follow-Up

et al. 2011

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Background/AimsEndoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for the management of biliary complications in liver transplant patients; however, its safety and efficacy have not been established in this setting. This study was performed to evaluate the safety and long-term efficacy of ERCP in transplant patients.MethodsThe case reports of 1,500 liver transplant patients were reviewed. Orthotopic liver transplantation (OLT) patients were matched 1:2 with non-OLT patients and followed-up for long-term outcome (median, 7.4 years).ResultsOf the 1,500 liver transplant patients, 94 (6.3%) underwent 150 ERCPs after OLT. Anastomotic strictures were present in 45 patients, biliary stones in 24, biliary leaks in 7, papillary stenosis in 2, and primary sclerosing cholangitis in 1. An ERCP success rate of 90.7% was achieved; biliary stenting led to resolution of the bile leak in 7/7 (100%) patients, and biliary stones were removed in 21/24 (87.5%) patients. In addition, 34 of 45 patients with anastomotic stricture underwent endoscopic dilation. We obtained complete resolution in 22/34 (64.7%) patients. OLT patients did not show a higher probability of complications (odds ratio [OR], 1.04), of pancreatitis (OR, 0.80) or of bleeding (OR, 1.34).ConclusionsERCP is safe and effective for the treatment of post-OLT biliary complications, has a low rate of pancreatitis and results in a durable effect.

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Endoscopic Retrograde Cholangiopancreatography in Patients With Biliary Complications After Orthotopic Liver Transplantation: Outcomes and Complications

Cited by 30 publications

References 12 publications

Complications after ERCP in liver transplant recipients

Complications after ERCP in liver transplant recipients

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

Safety and Efficacy of Endoscopic Retrograde Cholangiopancreatography in Patients with Post-Liver Transplant Biliary Complications: Results of a Cohort Study with Long-Term Follow-Up

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