P1054 - Indications and Outcomes of Early ERCP (<30 Days) After Deceased Cardiac Donor Liver Transplantation (DCD-LT)

Viveksandeep Thoguluva Chandrasekar, MBBS¹, Sailaja Pisipati, MBBS, FRCS¹, Jacqueline Cai, MD¹, Norio Fukami, MD, FACG¹, Douglas O. Faigel, MD, FACG¹, Bashar A. Aqel, MD², Rahul Pannala, MD^1
1Mayo Clinic, Scottsdale, AZ; ²Mayo Clinic, Phoenix, AZ

Introduction: DCD-LT is associated with increased risk of ischemic cholangiopathy, biliary strictures and anastomotic leaks, requiring early postoperative intervention. There is paucity of data on indications and outcomes of biliary intervention in early postoperative period. We evaluated ERCP indications and outcomes among DCD-LT patients when ERCP was performed early (≤30 days), compared to later ( >30 days) in the postoperative period.

Methods: Retrospective chart review of patients who had DCD-LT and ERCP at our center from 2014-2018 was performed (n=123). Patients were divided into two groups: early ERCP (≤30 days) vs later ( >30 days). We also evaluated outcomes in patients who underwent ERCP within 7 days of LT. Primary outcome was to elucidate and compare indications for ERCP in early and late phases. Secondary outcomes were incidence of post-procedural complications including pancreatitis, post-sphincterotomy bleeding, cholangitis, perforation, and incidence of re-transplant. Comparison of proportions was performed by Chi-squared test and p-value < 0.05 was considered significant.

Results: Among 123 patients with DCD LT who required ERCP, 44 (35.7%) required early ERCP (mean age: 58 ± 7, 68% males). AS were seen in 38 (86.3%) patients and IS in 6 (13.7%) patients in early ERCP group. Suspected or confirmed bile leak was the indication for ERCP in 9 patients (20.5%). Twelve patients (9.7%) required ERCP within 7 days, with 10 having AS (83.3%) and two patients with bile leak (16.7%). Comparing patients who required early and later ERCP from transplant, the incidence of bile leak, AS and IS were: 20.5% vs 5% (p = 0.008), 86.3% vs 78.4% (p = 0.28) and 13.7% vs 44.3% (p = 0.0006), respectively. Post-procedural complications were seen in 2 (4.5%) patients within 30 days (one within 7 days) and in 6 patients (7.6%) after 30 days (p = 0.5), respectively. Incidence of re-transplant for patients who had ERCP within and after 30 days of transplant were 4.5% vs 11.3% (p = 0.21), respectively. Mean number of stents used in index ERCP in early group was 1.2 ± 0.4 compared to 2 ± 0.8 (p < 0.05) in late ERCP group.

Discussion: Early ERCP, even in the first week after DCD-LT is equally safe as compared to ERCP performed later, with a low incidence of complications. Early ERCP is usually indicated for AS and bile leaks. Future studies should evaluate patient, surgical, and allograft factors that are predictive of early biliary complications in DCD-LT.



Disclosures:


Viveksandeep Thoguluva Chandrasekar, MBBS¹, Sailaja Pisipati, MBBS, FRCS¹, Jacqueline Cai, MD¹, Norio Fukami, MD, FACG¹, Douglas O. Faigel, MD, FACG¹, Bashar A. Aqel, MD², Rahul Pannala, MD¹. P1054 - Indications and Outcomes of Early ERCP (<30 Days) After Deceased Cardiac Donor Liver Transplantation (DCD-LT), ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.