Risks and Protective Factors of Post-Endoscopic Retrograde Cholangiopancreatography Complication in Patients Undergoing Liver Transplantation: A Systematic Review and Meta-analysis

Abstract

Background :

Liver transplantation is a critical treatment option for end-stage liver disease, albeit associated with potential complications. Among the most common post-transplant complications are biliary issues, including leaks, strictures, and obstructions. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently employed to manage these complications despite its inherent risks. While the complications of ERCP in the general population are well-documented, specific risks and protective factors for liver transplant recipients have not been extensively studied.

Materials and Methods:

We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. In order to find relevant studies published between 1/1/2011 and 1/3/2023, two independent researchers conducted searches (MT, I SH). A literature search of English language publications was conducted using MEDLINE through PubMed, EMBASETM through Ovid, the Cochrane Library, and Trip. In addition to Magiran and SID, we searched KoreaMed and LILACS for literature published in other languages. Endoscopic retrograde cholangiopancreatography OR ERCP,  OR liver Transplantation, OR Complication are terms used in the search strategy. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies, and data were independently extracted by two researchers.

Results :  

A total of 274 studies were selected. After analyzing their correspondence with the required criteria, a final review of eleven studies was conducted. Our meta-analysis identified several risk and protective factors for complications following ERCP in liver transplant patients. Protective factors included male sex and intraoperative stenting, which were associated with reduced complications. Conversely, high serum bilirubin and creatinine levels and a history of hepatitis B were found to increase the likelihood of complications or failure after ERCP. Factors such as age, history of diabetes, serum Alanine Aminotransferase (ALT) level, steroid administration, Mammalian Target of Rapamycin (mTOR) inhibitor use, and sphincterotomy did not significantly impact ERCP outcomes and complications.

Conclusion:

 This systematic review and meta-analysis provide valuable insights into the risk and protective factors associated with complications following ERCP in liver transplant recipients. These findings can inform clinical decision-making and guide healthcare providers in optimizing the management of post-transplant biliary complications.