Sedation-related complications during ERCP in liver transplant recipients: a retrospective cohort study

Liver transplant recipients frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications and may be at increased risk of sedation-related adverse events. However, data regarding sedation-related outcomes in this population remain limited. This study aimed to evaluate the incidence, characteristics, and potential predictors of sedation-related complications during ERCP in liver transplant recipients.

We conducted a retrospective cohort study including adult liver transplant recipients who underwent ERCP under anesthesiologist-administered deep sedation between July 2021 and June 2022. For patients who underwent multiple ERCP procedures, only the first procedure was included. Sedation-related complications were defined as the occurrence of one or more of the following events during ERCP or within 60 min after the procedure: oxygen desaturation, hypotension, bradycardia, apnea, or airway intervention. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complications.

A total of 76 patients were included. Sedation-related complications occurred in 21 procedures (27.6%). Oxygen desaturation was the most common event (22.4%), followed by hypotension (9.2%), apnea (3.9%), and bradycardia (2.6%). Airway intervention, consisting exclusively of jaw thrust maneuvers, was required in 10 procedures (13.2%). No patient required bag-mask ventilation, supraglottic airway placement, endotracheal intubation, or procedure termination due to sedation-related instability. In univariable analyses, longer procedure duration and higher propofol dose were associated with complications. No independent predictors were identified after multivariable adjustment. However, given the limited sample size and number of events, the study may have been underpowered to detect modest associations.

Sedation-related cardiopulmonary events were common but predominantly mild and transient. No independent predictors were identified after multivariable adjustment; however, the study may have been underpowered to detect modest associations.

Not applicable.