Clinical algorithm to guide the need for endoscopic retrograde cholangiopancreatography to evaluate early postliver transplant XXXX .

@entity1 @entity648 @entity1448 @entity492 @entity253 @entity3638
OBJECTIVES: Severe @entity1448 after liver transplant is common. In this study, our aim was to develop an algorithm to guide biliary intervention in these @entity1 . MATERIALS AND METHODS: A retrospective review was performed on @entity1 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. @entity1448 was defined as > than a 50% reduction in serum @entity648 within 48 hours of endoscopic retrograde cholangiogram intervention. RESULTS: Twelve @entity1 had endoscopic retrograde cholangiogram with 6 stents in 25 @entity1 with normal a hepatobiliary scan, and 2 @entity1 met criteria for @entity1448 . Twenty-two @entity1 had endoscopic retrograde cholangiogram with 14 stents in 32 @entity1 with delayed uptake, suggesting hepatocellular dysfunction on a hepatobiliary scan, and 4 @entity1 met criteria for @entity1448 . In the 57 @entity1 with severe @entity3638 , 6 @entity1 (11%) had @entity1448 as a cause. Among the 34 endoscopic retrograde cholangiograms performed, 17% had @entity253 . On multivariate analysis, @entity1 having both serum @entity492 transaminase concentrations < 1500 IU/L and serum total @entity648 levels > 257  mol/L had an odds ratio of 25.1 for predicting @entity253 (95% CI: 6-37; P = .002). CONCLUSIONS: A hepatobiliary scan with a combination peak serum @entity492 transaminase and peak serum total @entity648 levels offer a valuable tool to identify @entity1 with hepatocellular dysfunction and can avoid endoscopic retrograde cholangiogram in the immediate posttransplant period.
