Berk BAŞ, Ömer KÜÇÜKDEMİRCİ, Halil ŞAHİN
Journal of Health Sciences and Medicine - 2026;9(2):301-305
Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary modality for managing biliary complications after living donor liver transplantation (LDLT). Despite its widespread use, detailed data on cannulation strategies, technical challenges, and complication patterns in the post-transplant population remain limited. Methods: This retrospective cohort study included 467 patients who underwent ERCP between 2022 and 2025 at a high-volume tertiary liver transplant center. The LDLT cohort (n=70) was compared with a control group of non-transplant patients undergoing ERCP for benign biliary indications (n=397). Demographic characteristics, ERCP indications, technical parameters, cannulation methods, and 30-day complication rates were analyzed. Results: LDLT patients were significantly younger than controls (52.5 vs. 64.9 years, p<0.001). Biliary strictures were the predominant indication in the LDLT cohort (84.3%), whereas choledocholithiasis dominated in controls (69.5%). Although overall technical success was high and comparable (91.4% vs. 94.7%), LDLT patients required significantly more adjunctive cannulation techniques and demonstrated longer cannulation times (11.6+/-5.0 vs. 7.1+/-2.3 minutes, p<0.001). Pancreatic duct cannulation was more frequent in the LDLT group (25.7% vs. 10.6%, p<0.001), yet post-ERCP pancreatitis remained low (1.4%). Cholangitis (37.1% vs. 4.0%, p<0.001) and ICU admission (18.6% vs. 4.0%, p<0.001) were significantly more common among LDLT recipients, although no cholangitis-related mortality occurred. Conclusion: ERCP after LDLT is highly effective but technically more complex, requiring greater procedural expertise and exhibiting higher infectious complication rates. These findings highlight the need for experienced endoscopists and support further multicenter prospective studies to refine optimal cannulation strategies in transplant recipients.
