Gastrointestinal endoscopy · 2011
Complications after ERCP in liver transplant recipients.
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Balderramo Domingo, Bordas Josep M, Sendino Oriol, Abraldes Juan G, Navasa Miguel, Llach Josep, Cardenas Andres
Аннотация
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.
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.
Предметные рубрики MeSH
AgedCholangiopancreatography, Endoscopic RetrogradeCholangitisContrast MediaCreatinineFemaleHumansImmunosuppressive AgentsLength of StayLiver TransplantationLogistic ModelsMaleMiddle AgedMultivariate AnalysisPancreatitisPostoperative HemorrhagePrednisoloneRetrospective StudiesRisk FactorsSphincterotomy, EndoscopicTOR Serine-Threonine Kinases