title: Predictors of endoscopic treatment outcomes in the management of biliary problems after liver transplantation at a high-volume academic center.
abstract: BACKGROUND
  Biliary tract problems are the most common complications after liver transplantation. ERCP is increasingly being used to address posttransplantation biliary problems.
  
  
  OBJECTIVE
  To identify predictors of endoscopic treatment outcomes in the management of post-liver transplantation complications.
  
  
  METHODS
  All adult patients who underwent liver transplantation at the University of California, San Francisco between January 1999 and December 2008 were reviewed.
  
  
  METHODS
  A multivariate regression analysis.
  
  
  METHODS
  Identification of donor and recipient factors as well as technical considerations that predicted success or failure in the endoscopic management of posttransplantation biliary complications.
  
  
  RESULTS
  In 1062 patients who underwent liver transplantation, there were 224 biliary complications. ERCP was the primary treatment modality and was successful in the majority of patients treated. Patients with biliary complications who had take-back surgery for a nonbiliary indication during the first month after liver transplantation (odds ratio [OR], 0.32; P = .03), particularly for bleeding (OR, 0.18; P = .02), were less likely to respond to endoscopic therapy. Those who received a graft from a donor after cardiac death (OR, 0.15; P = .02) or a living donor (OR, 0.11; P < .01) were also less likely to respond to endoscopic therapy. Take-back surgery for a nonbiliary indication in the first month after liver transplantation was also identified as a novel risk factor for the development of biliary complications (OR, 1.80; P = .02).
  
  
  CONCLUSIONS
  Retrospective design.
  
  
  CONCLUSIONS
  ERCP can be used to treat the majority of posttransplantation biliary problems. However, endoscopic therapy is less efficacious in the treatment of complications associated with ischemia.
authors.affiliation: Division of Gastrointestinal and Liver Diseases, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Buxbaum
authors.forename: Scott W
authors.initials: SW
authors.lastname: Biggins
authors.forename: Karen C
authors.initials: KC
authors.lastname: Bagatelos
authors.forename: James W
authors.initials: JW
authors.lastname: Ostroff
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000601:surgery; D001659:Biliary Tract / Q000098:blood supply / Q000293:injuries / Q000473:pathology; D001660:Biliary Tract Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D015999:Multivariate Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome