Introduction
Endoscopic retrograde cholangiopancreatography (ERCP) is widely used for biliary diseases, yet safety data in transplant recipients remain scarce.
Aims & Methods
This study aimed to evaluate short-term survival and ERCP-related complications in transplant patients. We conducted a retrospective cohort study using the TriNetX database (December 2020–December 2024). Patients diagnosed with acute cholangitis who underwent ERCP were included. Transplant recipients were matched 1:1 with non-transplant controls without active cancer using propensity score matching. Outcomes assessed included survival (Kaplan-Meier analysis) and ERCP-related complications such as post-ERCP pancreatitis (PEP), sepsis, perforation, retroperitoneal abscess, liver abscess, blood transfusion, and emergency department visits.
Results
Before matching, 2,209 transplant recipients and 41,202 non-transplant controls met the inclusion criteria. After propensity score matching, 1,710 matched pairs were analyzed. Survival rates were comparable between transplant and non-transplant groups. Transplant recipients had significantly lower rates of PEP (HR: 0.591, 95% CI: 0.371–0.943, p=0.0254) and emergency department visits (HR: 0.667, 95% CI: 0.498–0.893, p=0.0061). Rates of other complications were not significantly different: sepsis (HR: 1.183, 95% CI: 0.799–1.754, p=0.4005), retroperitoneal abscess (HR: 1.514, 95% CI: 0.587–3.906, p=0.3468), liver abscess (HR: 1.377, 95% CI: 0.826–2.293, p=0.2176), perforation (HR: 2.088, 95% CI: 0.793–5.493, p=0.1272), and blood transfusions (HR: 1.642, 95% CI: 1.255–2.147, p=0.0003). Subgroup analysis of liver transplant patients showed lower PEP rates (HR: 0.592, 95% CI: 0.347–1.009, p=0.0510), but higher risks of retroperitoneal abscess (HR: 3.499, 95% CI: 0.976–12.544, p=0.0402), liver abscess (HR: 2.682, 95% CI: 1.303–5.521, p=0.0053), and blood transfusions (HR: 1.797, 95% CI: 1.282–2.518, p=0.0005).
Conclusion
ERCP appears safe in transplant recipients, demonstrating comparable short-term survival and overall complication rates to non-transplant patients. However, careful monitoring for post-ERCP bleeding and infections is particularly warranted in liver transplant recipients.
References
1. O'Connor HJ, Vickers CR, Buckels JA, McMaster P, Neuberger JM, West RJ, Elias E. Role of endoscopic retrograde cholangiopancreatography after orthotopic liver transplantation. Gut. 1991 Apr;32(4):419-23. doi: 10.1136/gut.32.4.419. PMID: 2026341; PMCID: PMC1379083.
2. Predictors of Early Repeat Endoscopic Retrograde Cholangiopancreatography After Liver Transplantation by Organ Donor TypeSinha, Jasmine et al. Techniques and Innovations in Gastrointestinal Endoscopy, Volume 24, Issue 2, 159 - 166
