Gender and Age in Orthotopic Liver Transplant (OLT) Recipients Correlates with Post Endoscopic Retrograde Cholangiopancreatography (ERCP) Length of Stay (LOS): Tertiary Care Center Study

Abstract

Purpose: Biliary complications after OLT can be treated with dilatation or stent placement during endoscopic retrograde cholangiopancreatography (ERCP). There has been a paucity of data about the effect of demographic variables in OLT patients (pts) on ERCP outcome. We correlated demographic variables with ERCP outcome in pts with history of OLT. Methods: Retrospective descriptive cohort study of patients undergoing ERCP after OLT for management of biliary complications from 2008 through end of May 2013 at our center. Results: 83 pts (M:63; F: 20) underwent 242 ERCP procedures, with median age 52.5 ± 16.7 yrs (M ± SD). The majority of patients were Caucasians (45.2%), followed by African Americans (38.1%) (AAs), Asians (2.4%) and Unknown (14.3%). Pts had an average of 3.1 ± 2.8 (M ± SD) ERCPs. The majority (60.3%) were done as outpatient procedures. 67.5% pts had greater than 1 ERCP. There was no difference in age, gender or race between patients who had single versus multiple ERCPs. Average length of inpatient stay after ERCP for males was less as compared to females (3.3 ± 0.6 days (M ± SEM) vs.8.3 ± 2.3), p=0.004. Pearson product moment coefficient revealed a positive correlation between increasing age and number of ERCP (r=0.18, p=0.005). Anastomotic and non-anastomotic strictures were found in 68.2% procedures. Post OLT follow up was no different (19.8 ± 1.9 months (M ± SEM) vs. 30 ± 16.9 months) in patients with and without a stricture. Males had a lower findings of stricture as compared to females (63.8% vs. 77.8%), p =0.05. Age for pts with stricture was 53.9 ± 1.1 yrs (M ± SEM) compared to 52.2 ± 1.6 yrs in pts without stricture, p = 0.4. Strictures were noted in 70.9% of the patients with multiple versus ERCP as compared to 37.9% in pts who had ERCP only once, p< 0.005. Conclusion: Male OLT recipients had a higher number of ERCP procedures with lower rate of observed strictures on ERCP as compared to females. Female OLT recipients had a longer inpatient stay after ERCP compared to males. Age directly correlated with the number of ERCP performed. Gender difference and effect of age on the ERCP outcome in pts with OLT needs to be explored further.