Risk factors of post‐endoscopic retrograde cholangiopancreatography pancreatitis among living‐donor liver transplant recipients with biliary complications

Abstract

AbstractThe aim of this study is to investigate the incidence of post‐ERCP (endoscopic retrograde cholangiopancreatography) pancreatitis (PEP) among living donor liver transplant (LDLT) recipients and the risk factors that may predispose to PEP. From December 2008 to August 2015, a total of 652 adult LDLT cases were performed at the Kaohsiung Chang Gung Memorial Hospital. LDLT recipients with biliary complications undergoing ERCP treatment were recruited in this study. PEP was assessed by using established consensus criteria. Patient‐ and procedure‐related factors were collected and analyzed to investigate the association with PEP. A total of 62 (9.5%) patients developed biliary complications after LDLT and received 223 ERCP procedures. Initial ERCP treatments were successful in 58 (93.5%) patients, and 4 (6.5%) patients failing in biliary cannulation proceeded to rendezvous procedure successfully. Pancreatic duct (PD) injection had the highest incidence (23.5%) of PEP followed by a short interval between LT and ERCP (<12 weeks) (18.5%), creatinine >2 mg/dl (16.6%), initial ERCP (16.1%), precut EST (13.8%), EST (12.9%), and use of prednisone (8.9%). Univariate analysis showed that initial ERCP, precut EST, PD injection, a short interval between LT and ERCP, and use of prednisolone were associated with PEP. However, multivariate analysis revealed that only initial ERCP (OR 17.2, 95% CI 1.9–150.2) and PD injection (OR 5.4, 95% CI 1.2–24.7) were independent risk factors of PEP among LDLT recipients. LDLT recipients undergoing initial ERCP and PD injection of contrast during the procedure are at a high risk to develop PEP. Prophylactic strategies should be adopted especially in this subset of patients.