P1142 - Outcomes in Admissions for Acute Cholangitis in Liver Transplant Recipients: A Nationwide Perspective

Bhanu Siva Mohan Pinnam, MD¹, Mihir P. Shah, MD², Daksh Ahluwalia, MD¹, Dushyant S. Dahiya, MD³, Abdul Mohammed, MD⁴, Clive J. Miranda, DO, MSc⁵, Abhin Sapkota, MD¹, Chun-Wei Pan, MD¹, Sanket Basida, MD⁶, Sahib Singh, MD⁷, Hema S. Pinnam, ⁸, Hemant Mutneja, MD¹, Seema Gandhi, MD¹, Sumant Inamdar, MD^9
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ²John H. Stroger, Jr. Hospital of Cook County, Cook County, IL; ³The University of Kansas School of Medicine, Kansas City, KS; ⁴AdventHealth, Orlando, FL; ⁵CHI Health Creighton University Medical Center, Omaha, NE; ⁶University of Missouri School of Medicine, Columbia, MO; ⁷Sinai Hospital, Baltimore, MD; ⁸Jagadguru Sri Shivarathreeshwara Medical College, Mysuru, Karnataka, India; ⁹University of Arkansas for Medical Sciences, Little Rock, AR

Introduction: Acute cholangitis (AC) is a potentially life-threatening bacterial infection of the biliary tract. Liver transplant (LT) recipients often have unique clinical profiles, including higher comorbidity rates and immunocompromised states. We aimed to compare adverse outcomes and ERCP utilization rates for AC in LT recipients and non-LT recipients.

Methods: The National Inpatient Sample 2016 through 2021 was utilized for this study. Using ICD-10 codes, patients with a principal diagnosis of AC were identified and divided into those with prior LT vs. those without LT. A multivariate regression analysis was used to adjust for potential confounders. A P-value of < 0.05 was considered statistically significant.

Results: A total of 66,225 hospitalizations for AC were identified, including 1,205 liver transplant recipients and 65,020 non-transplant patients. The mean age was lower in the LT group (50.29 ± 1.39 years) compared to non-transplant patients (65.80 ± 0.20 years). Transplant recipients had higher rates of chronic kidney disease (30.29% vs. 14.69%, p< 0.001) and diabetes mellitus (32.37% vs. 26.99%, p=0.076) but lower rates of congestive heart failure (3.72% vs 10.62%, P< 0.001), hypertension (32.37% vs. 43.84%, p< 0.001), and COPD (4.56% vs 10.53%, P=0.002). The mortality rate was 0.86% in non-LT patients and 0% among LT recipients. There was no statistically significant difference in the rates of ICU admission (1.24% vs. 1.36%; Odds ratio [OR] 0.898, 95% CI 0.28-2.88, p=0.857), severe sepsis (3.32% vs. 3.62%; OR 0.884, 95% CI 0.405-1.932, p=0.757) and blood transfusion requirement (3.73% vs. 2.01%; OR 1.683, 95% CI 0.811-3.492, p=0.162).

ERCP usage was significantly lower in transplant recipients (53.53% vs. 72.55%; OR 0.579, 95% CI 0.438-0.765, p< 0.001). Discharge disposition differed significantly, with transplant recipients more frequently discharged home (92.95% vs. 53.10%, p< 0.001). They were also less likely to be transferred to other facilities or require home healthcare.

Discussion: LT recipients with AC are younger and have different comorbidity profiles compared to non-LT patients. Despite higher comorbidity rates, transplant recipients exhibited similar or better outcomes in mortality, ICU admissions, and severe sepsis rates. The lower ERCP usage may indicate conservative clinical management strategies or opting for other drainage procedures like percutaneous biliary drainage. Further research is needed to optimize care strategies for this population.


Disclosures:


Bhanu Siva Mohan Pinnam, MD¹, Mihir P. Shah, MD², Daksh Ahluwalia, MD¹, Dushyant S. Dahiya, MD³, Abdul Mohammed, MD⁴, Clive J. Miranda, DO, MSc⁵, Abhin Sapkota, MD¹, Chun-Wei Pan, MD¹, Sanket Basida, MD⁶, Sahib Singh, MD⁷, Hema S. Pinnam, ⁸, Hemant Mutneja, MD¹, Seema Gandhi, MD¹, Sumant Inamdar, MD⁹. P1142 - Outcomes in Admissions for Acute Cholangitis in Liver Transplant Recipients: A Nationwide Perspective, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.