Introduction: Biliary complications are the most common cause of morbidity post orthotopic liver transplant (OLT), occurring in 5-32% of this patient population. Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for the management of these complications. Biliary complications in the early post-operative period (< 15 days) may be managed operatively or with ERCP. However, there is concern for an increased risk of complications with early ERCP, such as perforation, due to the presence of a fresh anastomosis. We examined the incidence of post – ERCP complications in patients status post OLT in relationship to the timing of the procedure.

Methods: We performed a retrospective review of 273 patients that underwent orthotopic liver transplant at our institution from 1/2012 – 4/2015. Among those patients who underwent ERCP, we analyzed the number and type of complications that occurred. There were 71 patients that underwent 204 ERCPs during this time. Only complications directly attributed to ERCP intervention were included. Post – ERCP complications included pancreatitis, bleeding, perforation/bile leak, ascending cholangitis and proximal stent migration. Complications were grouped based on number of days after liver transplant: Group 1 (< 15 days), Group 2 (15-42 days), or Group 3 (> 42 days).

Results: A total of 204 ERCPs were performed: 20 in group 1, 18 in group 2, and 166 in group 3. There were no statistically significant differences in mean age or MELD at time of transplant, warm ischemia time, or cold ischemia time between the 3 groups. No biliary balloon dilations were performed prior to 42 days. Complications occurred in group 1, 2, and 3 at a rate of 20% (OR 4.36, CI 1.21, 15.77, P=0.02), 0% (OR 0.44, CI 0.03, 8.02, P=0.59), and 5.4% (control), respectively.

Conclusions: Performing ERCP within 2 weeks of liver transplantation is associated with a statistically significant increased risk of complications compared to ERCP performed later in the post – operative course. ERCP should be performed with caution in patients less than 15 days post-transplant.

CITATION INFORMATION: Wolk B, Shiani A, Lipka S, Kumar A, Kemmer N, Pinkas H, Alsina A, Brady P, Turner A. Is Early Endoscopic Retrograde Cholangiopancreatography (ERCP) Safe Post Liver Transplant? Am J Transplant. 2016;16 (suppl 3).

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