Patients with Biliary Complications Following Orthotopic Liver Transplantation Can Be Successfully Managed by Serial Endoscopic Retrograde Cholangio-Pancreatography
Kaur R, Morales IC, Dhillon D, Ilias MS, Nagai S, Venkat D, Yoshida A, and Jafri S. Patients with Biliary Complications Following Orthotopic Liver Transplantation Can Be Successfully Managed by Serial Endoscopic Retrograde Cholangio-Pancreatography. Am J Transplant 2019; 19:866.
Am J Transplant
Purpose: We evaluated the quality of endoscopic intervention for biliary complications after liver transplantation in a diverse urban center.
Methods: A retrospective chart review of liver transplant recipients from 2015-2018 were included. Exclusion criteria included age >18, pre-transplant biliar-complications including strictures, leaks, primary biliary cirrhosis, primary sclerosing cholangitis, and previous cholecystectomy. Background information included age, race, and donor type (deceased brain death (DBD), deceased cardiac death (DCD), and living donor transplant (LDT)). 1st and 2nd FRCP data included biliary complications. Analysis was performed using chi-square and Fisher's exact tests.
Results: 320 patients received a liver transplantation over the course of academic years 2015 (Yl, n=36), 2016 (Y2, n=29), and 2017 (Y3, n=29) respectively. 63. 8% were male, 72. 3% Caucasian, with mean age 57. 4 years (range 23-71). Donors were 7. 4% LDT, 78. 7% DBD, and 13. 8% DCD. FRCP was performed on an average of 1. 97 months from transplant and an average of 2. 96 times per patient. Patients undergoing FRCP for Yl was 35. 6% Y2 23. 2% and Y3 31. 5% of total transplantations (p=0. 111). Initial FRCP showed abnonnal findings in 90. 2% including strictures (76. 1%), biliary sludge (28%), stones (16. 1%) and bile leak (7. 5%). 80% required a follow up FRCP, with 65. 8% having persistence of initial findings requiring repeat treatment. 28. 6% of patients with bile leak who underwent repeat FRCP had persistent leak. Presence of biliary complications did not significantly increase mortality. Death among patients receiving FRCP was 8. 5% versus 8. 0% of those not needing FRCP (p=0. 871). Repeat biliary surgety was needed in 4. 3% (p=0. 054), 42. 9% (p=0. 008), and 20% (p=0. 081) of patients with strictures, bile leak and stones on initial FRCP respectively. Death among patients with stricture, bile leak and biliaty stones was 4/66 (6. 1%), 1/7 (14. 3%), and 0/15 (0%) respectively. There was no statistical difference between Yl, Y2 and Y3 for overall positive find-ings on initial FRCP (p=1. 000), strictures (p=0. 980), bile leak (p=0. 886) or stones (p=1. 000). There was a trend towards increased bile leak among patients with histoty of intraoperative thrombectomy versus those without (20% vs 7. 5%). There were no differences between LDT, DCD and DBD for overall positive findings on initial ERCP(p=0. 814), strictures (p=0. 167), bile leak (p=0. 575) or stones (p=0. 167).
Conclusions: Initial FRCP when indicated, had a high likelihood of positive find-ings. Treatment on FRCP was most likely to be needed for patients with a stricture. Biliaty complications did not significantly impact death. FRCP alone was able to resolve the biliary issue in the vast majority of patients with abnormal findings.