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Post-endoscopic retrograde cholangiopancreatography cholangitis after endoscopic treatment of post-transplant biliary
Chengcheng Christine Zhang1,2, Ronald Koschny3,4, Christian Rupp3,5
1Department of Gastroenterology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. christine.zhang@med.uni-heidelberg.de.
Background And Aim:
Biliary strictures after liver transplantation are associated with significant morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred approach. Post-ERCP cholangitis is a complication of this procedure. We aimed to evaluate the incidence of post-ERCP cholangitis in patients with post-transplant biliary strictures, their impact on survival, and identify potential risk factors.
Methods:
This retrospective study evaluated liver transplant recipients with biliary strictures treated with balloon dilatation at defined intervals. Primary clinical endpoints were the incidence of post-ERCP cholangitis, overall survival, and identification of potential risk factors.
Results:
Two hundred patients with a median follow-up period of 6 years (IQR 2-10 years) were included. Anastomotic and non-anastomotic strictures were diagnosed in 132 and 68 patients, respectively. Overall, 930 ERCP procedures were performed, and post-ERCP cholangitis was detected in 148 procedures (15.9%). Patients with post-ERCP cholangitis showed significantly worse overall survival rates (median, 9 vs. 15 years; log-rank test, p < 0.001), were significantly more frequently diagnosed with non-anastomotic strictures (44.6% vs. 25%; p = 0.004), and had significantly higher treatment failure rates (n = 24/92; 26.1% vs. n = 13/108; 12%; p = 0.02) compared to those without cholangitis. Independent risk factors for cholangitis included the presence of non-anastomotic strictures (OR 3.1), and first-time ERCP intervention with sphincterotomy (OR 6.31).
Conclusions:
Post-ERCP cholangitis is a relevant complication of endoscopic treatment and is associated with the presence of non-anastomotic strictures and higher treatment failure rates. Since the success rate of endoscopic intervention in these complex strictures is limited, an optimized peri-interventional management and tailored antibiotic therapy may become particularly important for the further treatment and prognosis of these patients.
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