Tu1019 Development of the Metabolic Syndrome and Its Outcomes After Liver Transplantation

INTRODUCTION: Sirolimus has inhibitory effects on epithelial healing and cholangiocyte regeneration. In liver transplantation (LT) patients, these effects may be greatest at the biliary anastomosis. We therefore investigated whether sirolimus use is associated with need for early or emergent repeat therapeutic endoscopic retrograde cholangiography (ERC) in LT patients with anastomotic biliary stricture (ABS). METHODS: Medical records of patients who underwent LT from 1998-2009 at Johns Hopkins Hospital were reviewed, patients with ABS identified, and pertinent patient, surgical, and endoscopic data abstracted. The primary outcome was early repeat ERC, defined as need for early (i.e. unplanned) or emergent repeat therapeutic ERC accompanied by signs or symptoms suggestive of biliary obstruction and/or stent occlusion. Univariate and multivariate logistic regression analyses (adjusting for age, sex, LT to ERC time, and stent number) were performed to assess the association between sirolimus-based immunosuppression and early repeat ERC. RESULTS: 45 patients developed ABS and underwent a total of 156 ERCs. Early repeat ERC occurred (at a median of 26 days) in 14/56 (25%) and 6/100 (6%) ERCs performed with and without concomitant sirolimus-based immunosuppression, respectively (OR 1.22; 95% CI 1.02-1.45; p=0.03). In multivariate analysis, sirolimus use was associated with early repeat ERC (OR 1.24; 95% CI 1.04-1.47; p=0.015); this association remained significant when sirolimus dose was modeled as a continuous variable (OR 1.40 per mg/day; 95% CI 1.20-2.02; p=0.038). CONCLUSIONS: Sirolimus-based immunosuppression appears to be associated with a modest but significantly increased, dose-dependent risk of early repeat ERC in LT patients with ABS. Prospective studies are needed to further investigate these findings and determine if sirolimus use or dose should be reconsidered once ABS is diagnosed. Multivariate analysis of the association between sirolimus use and early repeat ERC