P0004 - Percutaneous Transhepatic Biliary Drainage versus Endoscopic Retrograde Cholangiopancreatography for Biliary Drainage in Liver Transplant Recipients

Bhanu Siva Mohan Pinnam, MD¹, Pius E. Ojemolon, MD¹, Dushyant S. Dahiya, MD², Abdul Mohammed, MD³, Mihir P. Shah, MD⁴, Saurabh Chandan, MD⁵, Harishankar Gopakumar, MD⁶, Sanket Basida, MD⁷, Daksh Ahluwalia, MD¹, Manesh Kumar Gangwani, MD⁸, Hemant Mutneja, MD¹, Seema Gandhi, MD¹, Mustafa Arain, MD³, Muhammad K. Hasan, MD³, Sumant Inamdar, MD^8
1John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; ²The University of Kansas School of Medicine, Kansas City, KS; ³AdventHealth, Orlando, FL; ⁴John H. Stroger, Jr. Hospital of Cook County, Cook County, IL; ⁵CHI Health Creighton University Medical Center, Omaha, NE; ⁶University of Illinois College of Medicine, Bloomington, IL; ⁷University of Missouri School of Medicine, Columbia, MO; ⁸University of Arkansas for Medical Sciences, Little Rock, AR

Introduction: Biliary complications are not an infrequent occurrence in liver transplant (LT) recipients. Biliary drainage is achieved with either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTBD). The ideal biliary drainage technique (ERCP vs. percutaneous drainage) remains a topic of debate. Hence, in this study, we aimed to compare adverse outcomes associated with PTBD and ERCP in this patient cohort.

Methods: We utilized the National Inpatient Sample (NIS) 2016 through 2020 to identify adult liver transplant recipients undergoing PTBD or ERCP. Hospitalization characteristics, adverse clinical outcomes, and healthcare burden were identified and compared.

Results: We identified 5,090 adult LT recipients receiving biliary drainage (635 via PTBD and 4,455 by ERCP). The PTBD cohort had a higher proportion of white patients (74.79% vs. 66.71%) and more complex discharge disposition, with higher rates of home healthcare use (40.94% vs 17.96%). The mortality rate was higher in the PTBD group (2.36% vs 1.01%). Still, after adjusting for confounders, the odds of mortality were not statistically significant [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 0.20-9.92, P-value 0.718]. The ERCP group experienced lower rates of cholangitis [13.13% vs 37.8%, aOR 0.27, 95% CI 0.17-0.43, P-value < 0.001], and sepsis [12.9% vs 32.28%, aOR 0.32, 95% CI 0.19-0.52, P-value< 0.001]. In the ERCP cohort, 1.79% experienced post-ERCP pancreatitis, and 0.11% were complicated by bowel perforation.

Discussion: Compared to PTBD, ERCP is associated with lower rates of adverse events, shorter lengths of stays, and lower hospitalization costs in liver transplant recipients. Considering these differences, when feasible, ERCP should be preferred over PTBD for biliary drainage in liver transplant recipients.


Disclosures:


Bhanu Siva Mohan Pinnam, MD¹, Pius E. Ojemolon, MD¹, Dushyant S. Dahiya, MD², Abdul Mohammed, MD³, Mihir P. Shah, MD⁴, Saurabh Chandan, MD⁵, Harishankar Gopakumar, MD⁶, Sanket Basida, MD⁷, Daksh Ahluwalia, MD¹, Manesh Kumar Gangwani, MD⁸, Hemant Mutneja, MD¹, Seema Gandhi, MD¹, Mustafa Arain, MD³, Muhammad K. Hasan, MD³, Sumant Inamdar, MD⁸. P0004 - Percutaneous Transhepatic Biliary Drainage versus Endoscopic Retrograde Cholangiopancreatography for Biliary Drainage in Liver Transplant Recipients, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.