title: Complications after ERCP in liver transplant recipients.
abstract: 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.
  
  
  METHODS
  Retrospective evaluation of all ERCPs performed in LT recipients at our institution during a 7-year, 4-month period.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A total of 243 ERCPs performed in 121 LT recipients with duct-to-duct anastomosis.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: GI/Endoscopy Unit, Institut de Malalties Digestives i Metaboliques, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Balderramo
authors.forename: Josep M
authors.initials: JM
authors.lastname: Bordas
authors.forename: Oriol
authors.initials: O
authors.lastname: Sendino
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.forename: Miguel
authors.initials: M
authors.lastname: Navasa
authors.forename: Josep
authors.initials: J
authors.lastname: Llach
authors.forename: Andres
authors.initials: A
authors.lastname: Cardenas
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002761:Cholangitis / Q000209:etiology*; D003287:Contrast Media / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010195:Pancreatitis / Q000209:etiology*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors
chemical_list: D003287:Contrast Media; D007166:Immunosuppressive Agents; D011239:Prednisolone; D003404:Creatinine; D058570:TOR Serine-Threonine Kinases