Award: Presidential Poster Award
Abbinaya Elangovan, MD1, Dalbir S. Sandhu, MD1, Gursimran S. Kochhar, MD, CNSC2
1Case Western Reserve University / MetroHealth Medical Center, Cleveland, OH; 2Allegheny Health Network, Pittsburgh, PA
Introduction: Post-ERCP pancreatitis (PEP) is the most common post-procedure complication of ERCP with an incidence of 3.5-15%. The prevalence of PEP and the role of immunosuppression in PEP among solid organ transplant (SOT) recipients is not well established. We aimed to study the prevalence of PEP and the effect of immunosuppressants in SOT recipients.
Methods: A retrospective analysis of 55 million individuals was performed using a cloud-based database, IBM Explorys. Explorys aggregates de-identified electronic health record data from 26 health care systems across the US and rounds to the closest 10 for statistical de-identification. PEP was defined as the elevation of lipase level > 500 U/L along with SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) diagnosis code of acute pancreatitis within 72 hours of ERCP procedure. The prevalence of PEP and the all-cause 30-day re-admission rate after an episode of PEP were calculated for SOT recipients (lung/kidney/heart/liver). Characteristics were compared using univariate chi-square test between SOT and non-transplant patients as well as liver transplant (LT) recipients and non-transplant patients. p < 0.05 was determined as statistically significant.
Results: There was no significant difference in the prevalence of PEP (8.03% vs 8.4%, p= 0.676) and re-admission rate (22.2% vs 20.3%, p = 0.645) between SOT recipients and non-transplant patients. Subgroup analysis of liver transplant (LT) recipients revealed a significantly lower rates of PEP (5.66% vs 8.4%, p = 0.002).
Compared to the general population, transplant recipients were less likely to be women [Odds ratio OR 0.567, 95% confidence interval CI (0.375 – 0.866), p = 0.008] (Table 1).
Among the transplant recipients, individuals with PEP were more likely to be under 50 years [OR 3.179, CI (1.980 - 5.102), p < 0.001]. PEP rates were lower with SOT recipients on steroids [OR 0.240 CI (0.113 - 0.509), p < 0.001] and calcineurin inhibitors [OR 0.078 CI (0.0317 - 0.194), p < 0.001] (Table 2).
Discussion: In this population-based study, the prevalence of PEP was not elevated in SOT recipients. Steroids and calcineurin inhibitors were associated with a protective effect against PEP. To our knowledge, this is the largest cohort to report on PEP in SOT recipients. Since population level database limits access to patients’ charts, studies with details on anatomical and peri-operative risk factors of PEP will further enhance our understanding in this specific subset of population.
Citation: Abbinaya Elangovan, MD; Dalbir S. Sandhu, MD; Gursimran S. Kochhar, MD, CNSC. P0564 - POST-ERCP PANCREATITIS IN SOLID ORGAN TRANSPLANT RECIPIENTS. Program No. P0564. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.