S2301 National In-Hospital Outcomes in Biliary Complications Post-Liver Transplant: ERCP vs PTC

Introduction: Our study evaluates national in-hospital outcomes in post-liver transplant patients who require ERCP or percutaneous transhepatic cholangiography (PTC) for the treatment of biliary complications, including strictures, leaks, or stones. Methods: National Inpatient Sample data from 2019 to 2021 was utilized to evaluate outcomes for post-liver transplant patients who required ERCP vs PTC for biliary complications. Liver transplants (both deceased and living donor) & ductal anastomoses of all types were included. Various demographics were assessed including age, biological sex, race, ethnicity, income quartile, & insurance status. Patients were categorized by procedure type utilizing ICD-10 codes. Primary outcomes were hospital length of stay (LOS), total charges, and in-hospital complications (mortality, sepsis, GI bleeding, and ICU use). Multivariate regression models adjusted for demographics and comorbidities helped assess differences in LOS, hospital costs, and in-hospital complications. STATA 19 was used for statistical analysis. P < 0.05 was deemed statistically significant. Results: Of a total of 3,045 weighted hospitalizations, 93.8% underwent an ERCP-only intervention. PTC-only was only 5.8% of patients. Only 0.5% of patients required combined ERCP & PTC. PTC-only had longer LOS (12.5 vs 7.8 days; P < 0.05) and higher hospital charges ($219,747 vs $113,832; P = 0.004). In-hospital complications such as sepsis were significantly higher in PTC-only (OR 2.08 [1.02–4.24]; P = 0.04). Other in-hospital complications such as mortality, ICU use, perforation, & pancreatitis did not differ significantly (P > 0.05). When comparing combined ERCP & PTC vs ERCP-only, there were no statistically significant differences in LOS (P = 0.95) or hospital charges (P = 0.35). Conclusion: ERCP remains the preferred first-line therapy post-liver transplant. PTC use, though infrequent, is linked to 59% longer LOS. PTC use is also noted to have 65% higher costs and an increased risk of sepsis with 2.08 times higher odds of developing sepsis. These disparities may be linked to more anatomically complex biliary complications in post-liver-transplanted patients, necessitating the use of PTC. Limitations of our study include its retrospective design, lack of access to procedural findings, & inability to determine biliary anatomy post-transplant (duct-to-duct anastomosis vs Roux-en-Y choledochojejunostomy). Despite these limitations, the large sample size & multivariate analysis strengthen our findings.