P1043 - Characterization of Readmission Risk for ERCP Within 6 Months of Liver Transplant

Neel Matiwala, BS¹, Rohan Tripathi, BS¹, Jay Shah, DO, MSc², Radhika Patel, MD³, Jason Doherty, PhD⁴, Soumojit Ghosh, MD^5
1Saint Louis University School of Medicine, St. Louis, MO; ²Franciscan Health Olympia Fields, Olympia Fields, IL; ³SSM Health Saint Louis University Hospital, St. Louis, MO; ⁴Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO; ⁵St. Louis University, St. Louis, MO

Introduction: Liver transplant (LT) remains a life saving procedure for patients with end stage liver disease. However, biliary complications such as strictures, stones and casts remain common within 6 months. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the preferred therapeutic procedure for these complications. Our study assesses the risks associated with readmission for ERCP within 6 months of LT.

Methods: This project used the National Readmission Database (NRD) to identify patients who were readmitted to the hospital for ERCP within 6 months of LT between 2016 to 2019. Patients less than 18 years of age and/or undergoing elective ERCP were excluded. Patient characteristics were found using ICD-10 codes. The primary outcome was the incidence of ERCP following LT with characterization by gender, age and Charlson comorbidity index (CCI). Readmission risk based on patient insurance was also assessed as a secondary outcome.

Results: Out of 15,085 hospital admissions within 6 months of LT, the incidence of readmission for ERCP was 8.55% (n=1,290). Table 1 describes subgroup characteristics. Logistic regression analysis found no difference between gender, age and CCI. However, further analysis found higher risk of readmission for ERCP within 6 months for patients with Medicaid compared to private insurance (OR: 1.34, CI 1.04-1.71, p< 0.02).

Discussion: Our study finds that patients with Medicaid have higher risk of readmission for ERCP after LT. Similarly, current literature finds liver transplant patients that transition from private insurance to Medicaid have more adverse outcomes1. Furthermore, living donor transplants are known to have more complications than split donations or orthotopic transplants2. Biliary strictures, the most common complication within a year of LT, are associated with advanced age, female donors, and transplant rejection. Although age did not increase risk in our study, more evidence is needed to correlate indications for ERCP in regards to socioeconomic status, donor characteristics and postoperative complications.

1. 
   Akateh et al, Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes, Jun 2018, 1463-1472.
   
   


2. 
   Boeva et al, Post-liver transplant biliary complications: Current knowledge and therapeutic advances, Jan 27 2021, 67-79.
   
   

Disclosures:


Neel Matiwala, BS¹, Rohan Tripathi, BS¹, Jay Shah, DO, MSc², Radhika Patel, MD³, Jason Doherty, PhD⁴, Soumojit Ghosh, MD⁵. P1043 - Characterization of Readmission Risk for ERCP Within 6 Months of Liver Transplant, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.