P1042 - Risk Factors for ERCP Readmission Within 30 Days 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 the only solution for end stage liver disease. The most common biliary complication within 30 days of LT is a bile leak. Endoscopic Retrograde Cholangiopancreatography (ERCP) with stent placement resolves 90% of early leaks1. Our study assesses the risks associated with readmission for ERCP within 30 days of LT.

Methods: This project used the National Readmission Database (NRD) to identify patients who were readmitted to the hospital for ERCP within 30 days 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 27,783 hospital admissions within 30 days of LT, the proportion with readmission for ERCP was 3.74% (n=1,039). Please see Table 1 for further subgroup characterization. Logistic regression analysis found that patients under the age of 65 had higher readmission risk compared to those ≥65 years old (OR 0.77, CI: 0.62-0.95, p< 0.01). No statistical differences in risk for ERCP were found between gender, comorbidity, or type of insurance (Medicare, Medicaid or private).

Discussion: Our study finds that younger age is associated with increased readmission risk for ERCP within 30 days following LT with no statistical difference in risk when stratified by comorbidity or insurance. Similarly, Mumtaz et al. finds general hospital readmission within 30 days after LT due to post-transplant complications with 85% of patients < 64 years of age (n = 21,308) suspecting poorer compliance to medical instructions or less support systems in younger generations. Additionally, bile leaks can occur at the site of anastomosis or upon removal of T-tubes if placed. This suggests that acute biliary complications may be more related to variations in LT procedures and previous bile duct disease rather than frailty or comorbidity. More evidence is needed to correlate reasons for LT and intraoperative variations with ERCP indications and their respective characterizations.

1. 
   Boeva et al, Post-liver transplant biliary complications: Current knowledge and therapeutic advances, Jan 27 2021, 67-79.
   
   


2. 
   Mumtaz et al, Thirty-day readmission rates, trends and its impact on liver transplantation recipients: a national analysis, Nov 6 2020, 1.
   
   

Disclosures:


Neel Matiwala, BS¹, Rohan Tripathi, BS¹, Jay Shah, DO, MSc², Radhika Patel, MD³, Jason Doherty, PhD⁴, Soumojit Ghosh, MD⁵. P1042 - Risk Factors for ERCP Readmission Within 30 Days of Liver Transplant, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.