S0044 Cholangitis in Patients With Post Liver Transplant Biliary Stricture: A Retrospective Cohort

Abstract

INTRODUCTION: Biliary stricture is one of the most common complications after liver transplantation. Stricture in the biliary tract can lead to other complications including cholangitis, which can be life threatening. The management of biliary strictures after liver transplant requires utilization of substantial healthcare resources. The aim of this study is to investigate the frequency of endoscopic interventions, risk factors and outcome in patients with known biliary stricture following liver transplantation who develop cholangitis. METHODS: In this retrospective cohort study, patients who had undergone liver transplantation and had a diagnosis of biliary stricture based on endoscopic retrograde cholangiopancreatography (ERCP), were included. Those with missing records and those who were followed for less than 6 months were excluded. The diagnosis of cholangitis was confirmed based on the assessment of treating gastroenterologist. Patients with at least one episode of cholangitis were compared to those without a history of cholangitis. RESULTS: Ninety-two patients with a history of liver transplantation and a confirmed diagnosis of biliary stricture were followed for an average of 55 months (range: 6 to >120). Overall, 28 patients (30.4%) had at least one episode of cholangitis, of whom 10 had more than one episode. Sixteen out of 28 (57.1%) had cholangitis within the first 6 months following liver transplantation. Patients with cholangitis had undergone more frequent endoscopic treatments for the management of their biliary stricture compared to those without cholangitis (5.3 ± 0.9 vs. 3.2 ± 0.3, P value: 0.007). Additionally, patients with cholangitis underwent a significantly higher number of total ERCPs (7.2 ± 0.9 vs. 4 ± 0.3, P value: 0.0001). There was no difference in cholangitis by patient age, gender, transplant type (deceased donor vs. living donor), or stricture type (anastomotic vs. non-anastomotic). CONCLUSION: The results of this study show that cholangitis is frequently seen in patients with post liver transplant biliary stricture. Compared to patients who do not develop cholangitis, those with cholangitis undergo a greater number of total ERCPs, as well and more procedures specifically performed for the management of their biliary strictures. Further studies with larger study populations are required to better characterize the risk factors and outcome of cholangitis in patients with post liver transplant biliary stricture.Table 1.: Comparing patients with post liver transplant biliary stricture who have cholangitis compared to those who do not.