Role of immunosuppression in post–endoscopic retrograde cholangiopancreatography pancreatitis after liver transplantation: A retrospective analysis

Authors

  • Ryan Law,

    1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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  • Carlos Leal,

    1. Gastrointestinal/Endoscopy Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
    2. August Pi i Sunyer Institute for Biomedical Research, Network Center for Biomedical Research in Hepatic and Digestive Diseases, Barcelona, Spain
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  • Barham Abu Dayyeh,

    1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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  • Michael D. Leise,

    1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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  • Domingo Balderramo,

    1. Gastrointestinal/Endoscopy Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
    2. August Pi i Sunyer Institute for Biomedical Research, Network Center for Biomedical Research in Hepatic and Digestive Diseases, Barcelona, Spain
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  • Todd H. Baron,

    Corresponding author
    1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
    • Address reprint requests to Todd H. Baron, M.D., Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. Telephone: 507-284-2174; FAX: 507-265-7612; E-mail: baron.todd@mayo.edu Address reprint requests to Andres Cardenas, M.D., M.M.Sc., A.G.A.F., Gastrointestinal/Endoscopy Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Villarroel 170, Esc 3-2, 08036 Barcelona, Spain. Telephone: (+34) 93 227 5513; FAX: (+34) 93 227 9850; E-mail: acardena@clinic.ub.es

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  • Andres Cardenas

    Corresponding author
    1. Gastrointestinal/Endoscopy Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
    2. August Pi i Sunyer Institute for Biomedical Research, Network Center for Biomedical Research in Hepatic and Digestive Diseases, Barcelona, Spain
    • Address reprint requests to Todd H. Baron, M.D., Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905. Telephone: 507-284-2174; FAX: 507-265-7612; E-mail: baron.todd@mayo.edu Address reprint requests to Andres Cardenas, M.D., M.M.Sc., A.G.A.F., Gastrointestinal/Endoscopy Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, Villarroel 170, Esc 3-2, 08036 Barcelona, Spain. Telephone: (+34) 93 227 5513; FAX: (+34) 93 227 9850; E-mail: acardena@clinic.ub.es

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  • Ryan Law contributed to the drafting of the manuscript and the final manuscript approval. Carlos Leal contributed to the analysis and interpretation of the data, a critical review, and the final manuscript approval. Barham Abu Dayyeh contributed to the analysis and interpretation of the data, a critical review, and the final manuscript approval. Michael D. Leise contributed to a critical review and the final manuscript approval. Domingo Balderramo contributed to a critical review and the final manuscript approval. Todd H. Baron contributed to the conception of the article, a critical review, and the final manuscript approval. Andres Cardenas contributed to the conception of the article, the analysis and interpretation of the data, a critical review, and the final manuscript approval.

  • No funding support was required for the publication of this article, and none of the authors have any conflicts of interest relevant to this research.

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used for diagnosis and therapeutic interventions in recipients of liver transplantation (LT) who develop biliary complications. Post–endoscopic retrograde cholangiopancreatography acute pancreatitis (PEP) is the most common major adverse event after ERCP; however, the frequency of PEP in LT recipients is not well established. We aimed to determine the rate of PEP in this population and to identify its predictors, especially among immunosuppressive agents. We reviewed all ERCP procedures performed in LT recipients after duct-to-duct biliary anastomoses at 2 high-volume transplant centers. Patients who had undergone sphincterotomy or had a surgically altered pancreaticobiliary anatomy before LT were excluded. Electronic medical records and endoscopy databases were used to obtain clinical, endoscopic, and medication data. A multivariate logistic regression analysis was used to determine predictors of PEP in this cohort. In all, 730 ERCP procedures were performed in 301 patients during the study period with an observed PEP rate of 3% (22/730). A univariate analysis revealed an increased risk of PEP with index ERCP after LT [odds ratio (OR) = 4.04, 95% confidence interval (CI) = 1.40-11.65] and in cases with difficult biliary cannulation (OR = 2.89, 95% CI = 1.10-7.65), whereas prednisone use was found to have a protective effect in both univariate (OR = 0.34, 95% CI = 0.14-0.84) and multivariate analyses (OR = 0.22, 95% CI = 0.09-0.57) after adjustments for difficult biliary cannulation and post-LT index ERCP. This retrospective analysis demonstrates that corticosteroid therapy has a protective role in the development of PEP in LT recipients. Further studies are warranted to confirm our findings. Liver Transpl 19:1354-1360, 2013. © 2013 AASLD.

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