Aims
Endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy is frequently used to manage biliary obstruction in patients with advanced liver disease. Its impact on post-orthotopic liver transplantation (OLT) biliary outcomes, however, remains unclear. This study evaluates whether ERCP performed before OLT influences the incidence, type, or severity of biliary complications after transplantation.
Methods
A retrospective analysis was conducted on 1128 OLT recipients, including 82 re-transplants, from January 2012 to December 2023. Seventy patients (6.2%) underwent pre-OLT ERCP with sphincterotomy (118 ERCPs total). Biliary complications occurring early (<30 days) or delayed (>30 days) post-OLT were compared between patients with and without pre-OLT ERCP. Outcomes included complication rates, need for endoscopic, radiologic, or surgical interventions, and post-complication mortality.
Results
Pre-OLT ERCP indications included biliary strictures (n=35), stones (n=24), bile leak (n=3), and other causes (n=8). Stents were placed in 33/70 patients. Pre-procedure adverse events occurred in 9 ERCPs (7.6%).
After OLT, 199 biliary complications occurred in 197 patients (17.5%). Complication rates did not differ between patients with (17.1%) and without (17.6%) pre-OLT ERCP (p = 0.91), showing no significant association between pre-OLT ERCP with sphincterotomy and overall post-OLT biliary complications, nor for early events or delayed events.
Among the 199 complications, treatment included ERCP (n=134), percutaneous drainage (n=20), surgery (n=29), or conservative management (n=16). ERCP-related adverse events occurred in 23/134 procedures.
Post-OLT mortality, during an average follow-up of 60.3 months, similar between patients with and without biliary complications (17.3% vs. 19.2%).
Conclusions
In this large cohort of OLT recipients, pre-transplant ERCP with sphincterotomy did not affect the risk of early or late post-OLT biliary complications. Rates of strictures, leaks, and biliary stones were comparable to those in patients without pre-OLT ERCP. These findings suggest that ERCP with sphincterotomy, when clinically indicated before transplantation, is safe and does not adversely influence post-transplant biliary outcomes.