title: Post-endoscopic retrograde cholangiopancreaticography complications in liver transplanted patients, a single-center experience.
abstract: BACKGROUND
  Complications in the biliary tract occur in 5%-30% after liver transplantation and the main part of the complications is successfully managed with endoscopic retrograde cholangiopancreaticography (ERCP). The incidence and risk factors for post-ERCP complications in liver transplantation patients are not well described. Our objective was to define the frequency of post-ERCP complications in liver transplantation patients at the Abdominal Center, Rigshospitalet, the only Liver Transplantation Center in Denmark.
  
  
  METHODS
  Retrospective study of all ERCPs performed in liver transplantation patients during a 9-year period.
  
  
  RESULTS
  A total of 292 ERCPs were included. Overall post-ERCP complications occurred in 24 procedures (8.2%): pancreatitis in 8 (2.7%), bleeding in 5 (1.7%), and cholangitis in 13 (4.5%) procedures. Simultaneous pancreatitis and cholangitis, and simultaneous bleeding and cholangitis occurred after two procedures, respectively. Multivariate analysis concerning overall complications identified biliary sphincterotomy (p = 0.006) and time since liver transplantation within 90 days postoperatively (p = 0.044) as risk factors for post-ERCP complications. Specifically concerning post-ERCP pancreatitis (PEP), it was found that pre-ERCP cholangitis was another independent risk factor for PEP (p = 0.026). Stent in the biliary tract prior to ERCP seemed to be protective (p = 0.041).
  
  
  CONCLUSIONS
  Complications were of surprisingly mild degree. The rates of post-ERCP complications in our study were in line with previous studies with liver transplantation patients. Cholangitis prior to ERCP may be another risk factor for post-ERCP pancreatitis.
authors.affiliation: Department of Surgical Gastroenterology, Liver Transplantation Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark riam@dadlnet.dk.
authors.forename: R B
authors.initials: RB
authors.lastname: Ambrus
authors.affiliation: Department of Surgical Gastroenterology, Liver Transplantation Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: L B
authors.initials: LB
authors.lastname: Svendsen
authors.affiliation: Department of Surgical Gastroenterology, Liver Transplantation Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: J G
authors.initials: JG
authors.lastname: Hillingsø
authors.affiliation: Department of Diagnostic Radiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Hansen
authors.affiliation: Department of Surgical Gastroenterology, Liver Transplantation Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: M P
authors.initials: MP
authors.lastname: Achiam
mesh_terms: D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Liver transplantation; cholangitis; complications; post-endoscopic retrograde cholangiopancreaticography complications; post-endoscopic retrograde cholangiopancreaticography pancreatitis