ERCP TREATMENT OF BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION IN MEXICO

Aims Evaluate and compare the effectiveness, safety and long-term outcomes of endoscopic treatment of biliary complications after liver transplant at a National referral center in Mexico.

Methods Retrospective review of liver transplant recipients who underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) after liver transplant between October 2015 and June 2019. Demographic data, indications for liver transplant, surgical technique employed, reason to perform an ERCP, number of procedures, complications, and technical, clinical and overall success rate were documented.

Results Between October 2015 and June 2019, eighty-eight deceased donor liver transplants were performed at National Medical Center November 20^th in Mexico City. There were 20 (23%) biliary related complications, 11/20 were female, median age was 55 years old (IQR 48–59). Complete hepatectomy and piggyback technique was used in all procedures. Median time from surgery to first endoscopic treatment was 3 months (IQR 2–10). Overall success rate for stenosis was achieved in 67% (12/18), 22% (4/18) are still under endoscopic biliary rehabilitation and in 11% (2/18) endoscopic management was deemed unsuccessful. Median time for biliary rehabilitation was 8 months (IQR 5–12), requiring a median of 3 procedures per patient (IQR 1–3). Self-expandable fully covered metal stents presented more migration rate when compared with plastic stents (44 vs 9%). Morbidity was present in 7% of patients and no mortality was documented.

Conclusions ERCP has proved to be safe and effective in the treatment of biliary complications in Mexican liver transplant recipients.