Endoscopic retrograde cholangiopancreatography and liver biopsy in the evaluation of elevated liver function tests after liver transplantation

Table 1 Baseline characteristics reported as n (%) or mean (SD)

Variable	Overall cohort (n = 91)
Age	51 (12.1)
Sex (male)	68 (74.7)
Presenting symptom
Jaundice	21 (23.1)
Fever	11 (12.1)
Abdominal pain	14 (15.4)
Asymptomatic	21 (25)
Liver biopsy performed first	51 (56)
Percutaneous liver biopsy	65 (71.4)
Bile duct diameter (mm)	4.6 (1.9)
R factor	2 (2.4), Range: 0.1-6.4
Alkaline phosphatase (international units/liter)	392.6 (248.4)
AST (units/liter)	200.5 (674.8)
ALT (units/liter)	205.4 (444.2)
Total bilirubin (mg/dL)	4.5 (5.4)
Deceased donor	73 (80.2)
Transplant biliary anatomy
Duct-to-duct	67 (73.6)
Roux-en-Y hepaticojejunostomy	24 (26.4)
Tacrolimus	66 (73.3)
Sirolimus	20 (22.2)
Everolimus	6 (6.6)
Mycophenolate sodium	28 (31.1)
Mycophenolate mofetil	13 (14.4)
Cyclosporine	16 (17.8)
Prednisone	20 (22.2)
Immunosuppression monotherapy	20 (22)
Dual immunosuppression therapy	68 (74.7)
Triple immunosuppression therapy	3 (3.3)

AST: Aspartate aminotransferase; ALT: Alanine transaminase.

Table 2 Etiologies of liver function test elevation reported as n (%)

Single diagnosis	n (%)
Anastomotic stricture	31 (34.1)
Acute cellular rejection	10 (11)
Recurrent primary sclerosing cholangitis	6 (19.4)
Recurrent HCV	5 (5.5)
Biliary cast syndrome	3 (3.3)
Ischemic cholangiopathy	2 (2.2)
Papillary stenosis	1 (1.1)
Posterior reversible encephalopathy syndrome	1 (1.1)
Cholestatic hepatitis	1 (1.1)
Recurrent PBC	1 (1.1)
Venous outflow obstruction	1 (1.1)
Two diagnoses
Anastomotic stricture and acute cellular rejection	13 (14.3)
Recurrent HCV and anastomotic stricture	6 (19.4)
Bile leak and acute cellular rejection	2 (2.2)
Congestive hepatopathy and anastomotic stricture	1 (1.1)
Anastomotic stricture and suprahepatic cava stenosis	1 (1.1)
Recurrent PBC and anastomotic stricture	1 (1.1)
CMV hepatitis and bile leak	1 (1.1)
Three diagnoses
Acute cellular rejection, anastomotic stricture, and recurrent HCV	2 (2.2)
Acute cellular rejection, anastomotic stricture, and de novo autoimmune hepatitis	1 (1.1)
Acute cellular rejection, anastomotic stricture, and CMV hepatitis	1 (1.1)

HCV: Hepatitis C virus; PBC: Primary biliary cholangitis; CMV: Cytomegalovirus.

Table 3 Operating characteristics for endoscopic retrograde cholangiopancreatography and liver biopsy in diagnosing post-liver transplant complications

	ERCP	LB	ERCP + LB
Overall accuracy % (95%CI)	79.1 (69.3-86.9)	93.4 (86.2-97.5)	100 (96-100)
Overall sensitivity % (95%CI)	79.1 (69.3-86.9)	93.4 (86.2-97.5)	100 (96-100)
Acute cellular rejection accuracy % (95%CI)	0 (0-30.9)	100 (69.2-100)	100 (91.9-100)
Anastomotic stricture accuracy % (95%CI)	100 (84.6-100)	72.7 (49.8-89.3)	100 (89.4-100)

ERCP: Endoscopic retrograde cholangiopancreatography; LB: Liver biopsy.