Oral (pre-recorded)
General HPB 		  
OG01 General HPB: Endoscopy 
Selection of Presentations from Abstract Submissions
OG01-01 Risk Factors for Endoscopic Biliary Tract Interventions Following Orthotopic Liver Transplantation: An Analysis of 10,252 Patients over 15 Years Across the United States
Krishnaraj Mahendraraj, United States

K. Mahendraraj, N. Nissen, K. Kosari, T. Brennan, G. Voidonikolas, A. Klein, T. Todo, I. Kim
Surgery, Cedars-Sinai Medical Center, United States

Introduction: Endoscopic biliary tract interventions following orthotopic liver transplantation (OLT) are being utilized more commonly now with advancements in endoscopic technique and technology. This study assesses the risk factors for endoscopic procedures following OLT.
Method: Data on 10,252 OLT patients from the National Inpatient Sample database who underwent post-transplant endoscopic biliary procedures (EBP) was analyzed over a 15-year period (2001-2016).
Results: 581 patients who had EBP were identified. Of these, 467 (80.4%) had ERCP, sphincterotomy and stenting. The remainder had ERCP alone. EBP and non-EBP patients had a similar demographic and comorbidity profile. The strongest risk factors for EBP post-OLT on multivariate analysis were biliary anastomotic stricture (OR 6.1), bile leak/fistula (OR 5.4), choledocholithiasis (OR 5.0), cholangitis (OR 4.2), age>60 (OR 2.1), living donor graft (OR 1.9), and emergency admission status (OR 1.1), p< 0.05. Conversely, roux-en-y hepaticojejunostomy and age< 20 were associated with fewer EBP, p< 0.05. EBP was associated with a significantly longer length of stay (98.3% stayed over 1 week), and higher risk of post-procedure biliary sepsis (23.2% vs 11.8%), graft abscess (11.4% vs 6%), acute graft rejection (46.1% vs 18.4%), and inpatient mortality (7.2% vs 5.3%), p< 0.05.
Conclusions: OLT recipients who develop postoperative biliary complications (especially anastomotic strictures), older than 60, have living donor grafts and have non-elective admissions are at highest risk of undergoing EBP. Although unavoidable in many situations, EBP is associated with significantly greater morbidity and mortality post-OLT. Clinicians must be cognizant of these risks when considering EBP in OLT recipients.
[Clinical Profile of 10,252 Liver Transplant Patients from the NIS Database (2001-2016)]