A clinical algorithm to guide the need for endoscopic retrograde cholangiopancreatography to evaluate early postliver transplant cholestasis

Satheesh Nair, Shilpa Lingala, Sanjaya Satapathy, James D. Eason, Jason M. Vanatta

Research output: Contribution to journalArticle

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Abstract

Objectives: Severe cholestasis after liver transplant is common. In this study, our aim was to develop an algorithm to guide biliary intervention in these patients.

Materials and Methods: A retrospective review was performed on patients who had undergone a hepatobiliary scan, with or without subsequent endoscopic retrograde cholangiogram, during the immediate postoperative period. These findings were evaluated along with laboratory values to determine the benefit for this evaluative process. Biliary duct obstruction was defined as > than a 50% reduction in serum bilirubin within 48 hours of endoscopic retrograde cholangiogram intervention.

Conclusions: A hepatobiliary scan with a combination peak serum aspartate transaminase and peak serum total bilirubin levels offer a valuable tool to identify patients with hepatocellular dysfunction and can avoid endoscopic retrograde cholangiogram in the immediate posttransplant period.

Results: Twelve patients had endoscopic retrograde cholangiogram with 6 stents in 25 patients with normal a hepatobiliary scan, and 2 patients met criteria for biliary duct obstruction. Twenty-two patients had endoscopic retrograde cholangiogram with 14 stents in 32 patients with delayed uptake, suggesting hepatocellular dysfunction on a hepatobiliary scan, and 4 patients met criteria for biliary duct obstruction. In the 57 patients with severe hyperbilirubinemia, 6 patients (11%) had biliary duct obstruction as a cause. Among the 34 endoscopic retrograde cholangiograms performed, 17% had biliary obstruction. On multivariate analysis, patients having both serum aspartate transaminase concentrations < 1500 IU/L and serum total bilirubin levels > 257 μmol/L had an odds ratio of 25.1 for predicting biliary obstruction (95% CI: 6-37; P =. 002).

Original languageEnglish (US)
Pages (from-to)543-547
Number of pages5
JournalExperimental and Clinical Transplantation
Volume12
Issue number6
DOIs
StatePublished - Dec 1 2014

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Endoscopic Retrograde Cholangiopancreatography
Cholestasis
Transplants
Aspartate Aminotransferases
Serum
Bilirubin
Stents
Hyperbilirubinemia
Postoperative Period
Multivariate Analysis
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Transplantation

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A clinical algorithm to guide the need for endoscopic retrograde cholangiopancreatography to evaluate early postliver transplant cholestasis. / Nair, Satheesh; Lingala, Shilpa; Satapathy, Sanjaya; Eason, James D.; Vanatta, Jason M.

In: Experimental and Clinical Transplantation, Vol. 12, No. 6, 01.12.2014, p. 543-547.

Research output: Contribution to journalArticle

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