Effect of immunsuppressive treatment type on post-ercp pancreatitis development after liver transplantation

Introduction and aims: Liver transplantation is a successful and common treatment method for end-stage liver patients. Immunosuppressive agents and advances in technology have increased the therapeutic potential of liver transplantation to higher levels. Biliary complications occur in 5-30% of patients after liver transplantation. Endoscopic retrograde cholangiopancreatography (ERCP); has replaced surgery as the gold standard procedure for the diagnosis and treatment of biliary complications in liver transplant recipients. Pancreatitis is the most common complication after ERCP. The frequency and risk factors of post-ERCP pancreatitis (PEP) in liver transplant patients have not been fully determined. We aimed to determine the risk factors for the development of PEP in this population and to determine the relationship between immunosuppressive agents and PEP in particular. Materials and Methods: In this single-center, clinical, retrospective study, 1338 patients who underwent ERCP after liver transplantation were included. Age, gender, transplant etiology of the cases, type of anastomosis during the procedure, whether EST was performed before, whether pre-incision was made, whether stent was applied to the common bile duct during the procedure, the type of immunosuppressive treatment agent used, whether they received antibiotic treatment after the procedure, ERCP indication, number of ERCP sessions data on the state of being pancreatitis were collected. Having EST before decreases pancreatitis by 70.4%. Results: A multivariate logistic regression analysis was used to determine the determinants of PEP in this cohort. 1174 sessions of ERCP procedures were performed throughout the study period with an observed PEP rate of 4.9% (66/1338) in total. Statistically significant relationship was not found between the variables of age, gender, lobe, anastomosis type, immunosuppressive treatment agent and stent and the state of having pancreatitis (p>0.05). The risk of having post-ercp pancreatitis is 3.886 times higher in those who had pre-incision during ERCP compared to those who did not. The probability of developing pancreatitis was found to be 59% in patients with ERCP sessions> 6 and above. The incidence of receiving antibiotic treatment after ERCP has increased in patients with stenting during the procedure (p=0.037). Antibiotic usage rates were examined in patients who had pre-incision during ERCP (p=0.04) and patients who had previously undergone EST (p=0.03), and it was found statistically that antibiotic use increased in both groups. Conclusion: PEP risk factors have been investigated in many different societies around the world, and there is no study conducted in the Turkish population that examines the effect of high-volume, especially immunosuppressive agents, on PEP. In our retrospective study, no protective effect of any immunosuppressant treatment agent, including prednisolone and tacrolimus, on the development of pancreatitis was found. More studies are needed to confirm our findings and to examine the role of immunosuppressive agents in PEP. Keywords: Liver Transplantation, ERCP, PEP, Immunosuppression