Digestive Diseases and Sciences

, Volume 55, Issue 12, pp 3602–3609 | Cite as

Effect of ERCP Utilization and Biliary Complications on Post-Liver-Transplantation Mortality and Graft Survival

  • A. Sidney BarrittIV
  • C. Brock Miller
  • Paul H. Hayashi
  • Evan S. Dellon
Original Article



Biliary complications after liver transplant are a frequent source of morbidity. However, little recent mortality data exists related to endoscopic management of these complications.


To determine the effect of endoscopic retrograde cholangiopancreatography (ERCP) utilization and biliary complications on patient and graft survival after liver transplantation.


This study was a retrospective cohort study at the University of North Carolina Hospitals from 2004 to 2007. One hundred thirty-two consecutive liver transplant patients were included. Recipient, donor, and clinical data were extracted from electronic resources. The main outcome measurements were all-cause mortality and graft failure.


Of 132 transplants, 59 (45%) required ERCP post transplant, and 49 (37%) were found to have a biliary complication by ERCP. The 1-year patient survival for those treated by ERCP with a biliary complication was 90% compared with 81% in those without a biliary complication [P = 0.018; unadjusted hazard ratio (HR) = 0.32; 95% confidence interval (CI) 0.11–0.93]. The 1-year graft survival in those with and without a biliary complication was 94% and 73%, respectively (P < 0.001; unadjusted HR 0.19; 95% CI 0.07–0.56). This effect on patient and graft survival persisted after multivariate analysis. Similar results were seen for ERCP utilization alone, and when early deaths within the first 30 days were excluded.


Patients who underwent ERCP for a biliary complication post liver transplantation had better overall and graft survival than patients who did not have an ERCP. Biliary complications and ERCP utilization are common after liver transplant, but they do not confer excess mortality.


Liver transplantation Endoscopic retrograde cholangiopancreatography ERCP Biliary complication Mortality 



Endoscopic retrograde cholangiopancreatography


Orthotopic liver transplant


Hazard ratio


United Network of Organ Sharing


Model for end-stage liver disease


Acute hepatic failure



This research was supported, in part, by a grant from the National Institutes of Health T32 DK07634.

Conflicts of interest



  1. 1.
    Verdonk RC, Buis CI, Porte RJ, Haagsma EB. Biliary complications after liver transplantation: A review. Scand J Gastroenterol Suppl. 2006;89–101.Google Scholar
  2. 2.
    Tung BY, Kimmey MB. Biliary complications of orthotopic liver transplantation. Dig Dis. 1999;17:133–144.CrossRefPubMedGoogle Scholar
  3. 3.
    Thuluvath PJ, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation. Liver Int. 2003;23:156–162.CrossRefPubMedGoogle Scholar
  4. 4.
    Klein AS, Savader S, Burdick JF, et al. Reduction of morbidity and mortality from biliary complications after liver transplantation. Hepatology. 1991;14:818–823.CrossRefPubMedGoogle Scholar
  5. 5.
    Stratta RJ, Wood RP, Langnas AN, et al. Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation. Surgery. 1989;106:675–683. discussion 683-674.PubMedGoogle Scholar
  6. 6.
    Lopez RR, Benner KG, Ivancev K, Keeffe EB, Deveney CW, Pinson CW. Management of biliary complications after liver transplantation. Am J Surg. 1992;163:519–524.CrossRefPubMedGoogle Scholar
  7. 7.
    Greif F, Bronsther OL, Van Thiel DH, et al. The incidence, timing, and management of biliary tract complications after orthotopic liver transplantation. Ann Surg. 1994;219:40–45.CrossRefPubMedGoogle Scholar
  8. 8.
    Lerut J, Gordon RD, Iwatsuki S, et al. Biliary tract complications in human orthotopic liver transplantation. Transplantation. 1987;43:47–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Lemmer ER, Spearman CW, Krige JE, et al. The management of biliary complications following orthotopic liver transplantation. S Afr J Surg. 1997;35:77–81.PubMedGoogle Scholar
  10. 10.
    Davidson BR, Rai R, Nandy A, Doctor N, Burroughs A, Rolles K. Results of choledochojejunostomy in the treatment of biliary complications after liver transplantation in the era of nonsurgical therapies. Liver Transpl. 2000;6:201–206.PubMedGoogle Scholar
  11. 11.
    Kuo PC, Lewis WD, Stokes K, Pleskow D, Simpson MA, Jenkins RL. A comparison of operation, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography in biliary complications after hepatic transplantation. J Am Coll Surg. 1994;179:177–181.PubMedGoogle Scholar
  12. 12.
    Osorio RW, Freise CE, Stock PG, et al. Nonoperative management of biliary leaks after orthotopic liver transplantation. Transplantation. 1993;55:1074–1077.CrossRefPubMedGoogle Scholar
  13. 13.
    Johnston TD, Reddy KS, Khan TT, Ranjan D. Ercp in the management of early versus late biliary leaks after liver transplantation. Int Surg. 2006;91:301–305.PubMedGoogle Scholar
  14. 14.
    Fogel EL, Sherman S, Park SH, McHenry L, Lehman GA. Therapeutic biliary endoscopy. Endoscopy. 2003;35:156–163.CrossRefPubMedGoogle Scholar
  15. 15.
    Sanna C, Saracco GM, Reggio D, et al. Endoscopic retrograde cholangiopancreatography in patients with biliary complications after orthotopic liver transplantation: Outcomes and complications. Transplant Proc. 2009;41:1319–1321.CrossRefPubMedGoogle Scholar
  16. 16.
    Tabibian JH, Asham EH, Goldstein L, et al. Endoscopic treatment with multiple stents for post-liver-transplantation nonanastomotic biliary strictures. Gastrointest Endosc. 2009;69:1236–1243.CrossRefPubMedGoogle Scholar
  17. 17.
    Pasha SF, Harrison ME, Das A, et al. Endoscopic treatment of anastomotic biliary strictures after deceased donor liver transplantation: Outcomes after maximal stent therapy. Gastrointest Endosc. 2007;66:44–51.CrossRefPubMedGoogle Scholar
  18. 18.
    Rizk RS, McVicar JP, Emond MJ, et al. Endoscopic management of biliary strictures in liver transplant recipients: Effect on patient and graft survival. Gastrointest Endosc. 1998;47:128–135.CrossRefPubMedGoogle Scholar
  19. 19.
    Pfau PR, Kochman ML, Lewis JD, et al. Endoscopic management of postoperative biliary complications in orthotopic liver transplantation. Gastrointest Endosc. 2000;52:55–63.CrossRefPubMedGoogle Scholar
  20. 20.
    Dellon ES, Kohn GP, Morgan DR, Grimm IS. Endoscopic retrograde cholangiopancreatography with single-balloon enteroscopy is feasible in patients with a prior roux-en-y anastomosis. Dig Dis Sci. 2008.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • A. Sidney BarrittIV
    • 1
  • C. Brock Miller
    • 1
  • Paul H. Hayashi
    • 1
  • Evan S. Dellon
    • 1
  1. 1.Division of Gastroenterology and HepatologyUniversity of North Carolina School of MedicineChapel HillUSA

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