Krishnaraj Mahendraraj, MD, Guillermo Medrano Del Rosal, MD, Michelle Kruse, BS. Lincoln Medical Center
Introduction: Biliary tract complications that require endoscopic decompression represent a greater challenge after liver transplantation than in non transplanted patients. Immunosuppressive therapy predisposes patients to a greater risk of infections and poor healing process. This comparative study analyzes risk factors and outcomes in liver transplant patients with biliary pathology that requires endoscopic intervention.
Methods: Information obtained from National Inpatient Sample database over a 15-year period (2001-2011). This included a total 10,252 patients who underwent liver transplantation, 581(6%) if these patients experienced biliary system complications. Univariate and multivariate was obtained via Statistical Package for the Social Sciences (SPSS). Statistical significance was accepted for p-value < 0.05.
Results: A total of 581 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) after hepatic transplantation, 80% of them had sphincterotomy and stent placement. These were mostly seen in men (64.5%), caucasians (69.8%) with a mean age of 52 years, however these results were similar to the no intervention group. These patients were diabetic with chronic complications (4.9% vs 2.9%) and had congestive heart failure (3.8% vs 2.4%). Choledochoenterostomy was a protective factor for having biliary pathology requiring endoscopic intervention. Biliary complications that required intervention were; choledocholithiasis (18.8% vs 9.5%), cholangitis (36.7% vs 7.5%), biliary stricture (36.7% vs 3.8%), biliary leak (0.7% vs 0.1%). Length of stay > 1 week was greater in the biliary intervention group (98.3% vs 77.6%). Significant complications seen in patients requiring intervention were; sepsis (23.2% vs 11.8%), urinary tract infections (12.6% vs 8.5%), acute renal failure (39.9% vs 31.1%), peritonitis or intra abdominal abscess (11.4% vs 6.0%), wound infection (11.7% vs 6.0%) and acute rejection (46.1% vs 18.4%). In-hospital mortality was significantly higher for patients with biliary pathology requiring endoscopic intervention (7.2% vs 5.3%).
Conclusion: Biliary system pathologies requiring endoscopic intervention had life threatening complications and thus mortality rate on the same admission. Interestingly, choledochoenterostomy decreased the risk of biliary tract pathology that required instrumentation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93480
Program Number: P230
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster