Mohammad Alomari, MD1, Muhammad Talal Sarmini, MD1, Mohammad Maysara Asfari, MD2, Laith Al Momani, MD3, Fredy Nehme, MD4, Tyler Aasen, MD3, Mark Young, MD3
1Cleveland Clinic Foundation, Cleveland, OH; 2Augusta University, Augusta, GA; 3East Tennessee State University, Johnson City, TN; 4University of Missouri, Kansas City, MO
Introduction: Patients with renal transplant (RT) are prone to higher rates of complications after procedures and surgical interventions. The literature that evaluates the outcomes of endoscopy retrograde cholangiopancreatography (ERCP) in RT patients is scarce. Therefore, we conducted this study to evaluate the outcomes of ERCP in RT patients using a large nationwide inpatient database.
Methods: Using data from the National Inpatient Sample (NIS) database between 2011 and 2014, we identified all patients who underwent ERCP using appropriate ICD 9 coding. Afterwards, we divided patients who had ERCP into two groups: patients with RT (study group) and patients without RT (control group). Primary outcomes included post ERCP adverse effects (AE): post ERCP pancreatitis (PEP), bleeding, and perforation. Secondary outcomes included inpatient mortality (IM) and length of stay (LOS). AEs and mortality were compared using multivariate logistic regression analysis after adjusting for potential cofounding factors including: (age, race, gender, smoking, and Elixhauser comorbidities).
Results: A total of 108,199 patients underwent ERCP, of which 343 (0.32%) had RT. RT patients were younger (median age: 58 vs. 59), less likely to be female (48.1% vs. 59.8%), and more likely to be African American (12.1% vs. 9.1%) compared to the control group, (P < 0.05). In addition, RT patients were less likely to have alcohol abuse (2% vs. 4.1%) and smoking (3.8% vs. 12.1%) compared to the control group, (P < 0.05). (Table 1)Using multivariate logistic regression, individuals in the RT group had a statistically significant higher odds for PEP (OR 1.61, 95% CI: 1.05 - 2.47, P < 0.05) compared with the control group. On the other hand, there was no statistically significant difference between the two groups in bleeding (OR 1.32, 95% CI: 0.42 - 4.14, P >0.05) and IM (OR 0.97, 95% CI: 0.31- 3.06, P >0.05). The post ERCP perforation rate was 0.04% (n=48) in the control group while the RT group had no reported perforations. Finally, the adjusted LOS was longer in the RT group compared to the control group (6.51 vs 5.49, P < 0.05). (Figure 1)
Discussion: This is one of the largest studies that assessed the outcomes of ERCP in RT patients to date. Our analysis showed that patients with RT had increased risk for PEP, while there was no significant difference in the post ERCP bleeding rate or IM. Careful selection and close monitoring for RT patients requiring ERCP is warranted to avoid complications in this population.
Citation: Mohammad Alomari, MD; Muhammad Talal Sarmini, MD; Mohammad Maysara Asfari, MD; Laith Al Momani, MD; Fredy Nehme, MD; Tyler Aasen, MD; Mark Young, MD. P0932 - THE SAFETY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN RENAL TRANSPLANT PATIENTS. Program No. P0932. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.