{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:48:49Z","timestamp":1790138929068,"version":"4.0.1"},"reference-count":37,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Liver transplant recipients often require endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications, which can lead to infections. This retrospective single-center study aimed to identify risk factors for infectious complications following ERCP in liver transplant patients. Methods: A retrospective analysis was conducted on 285 elective ERCP interventions performed in 88 liver transplant patients at a tertiary care center. The primary endpoint was the occurrence of an infection following ERCP. Univariable and multivariable regression analyses, Cox regression, and log-rank tests were employed to assess the influence of various factors on the incidence of infectious complications. Results: Among the 285 ERCP interventions, isolated anastomotic stenosis was found in 175 cases, ischemic type biliary lesion (ITBL) in 103 cases, and choledocholithiasis in seven cases. Bile duct interventions were performed in 96.9% of all ERCPs. Infections after ERCP occurred in 46 cases (16.1%). Independent risk factors for infection included male sex (OR 24.19), prednisolone therapy (OR 4.5), ITBL (OR 4.51), sphincterotomy (OR 2.44), cholangioscopy (OR 3.22), dilatation therapy of the bile ducts (OR 9.48), and delayed prophylactic antibiotic therapy (&gt;1 h after ERCP) (OR 2.93). Additionally, infections following previous ERCP interventions were associated with an increased incidence of infections following future ERCP interventions (p &lt; 0.0001). Conclusion: In liver transplant patients undergoing ERCP, male sex, prednisolone therapy, and complex bile duct interventions independently raised infection risks. Delayed antibiotic treatment further increased this risk. Patients with ITBL were notably susceptible due to incomplete drainage. Additionally, a history of post-ERCP infections signaled higher future risks, necessitating close monitoring and timely antibiotic prophylaxis.<\/jats:p>","DOI":"10.3390\/jcm13051438","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T06:07:53Z","timestamp":1709273273000},"page":"1438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Norman","family":"K\u00fchl","sequence":"first","affiliation":[{"name":"University of M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Vollenberg","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rn Arne","family":"Meier","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hansj\u00f6rg","family":"Ullerich","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin Sebastian","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Rennebaum","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim","family":"Laleman","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"},{"name":"Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neele Judith","family":"Frob\u00f6se","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, University Hospital Muenster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Praktiknjo","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Peiffer","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyi","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2757-4755","authenticated-orcid":false,"given":"Phil-Robin","family":"Tepasse","sequence":"additional","affiliation":[{"name":"Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital M\u00fcnster, 48149 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1097\/MEG.0000000000002640","article-title":"Epidemiology of liver transplantation and post-LT complications in Germany: Nationwide study (2005 to 2018)","volume":"35","author":"Gu","year":"2023","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.gie.2014.06.045","article-title":"Incidence, severity, and mortality of post-ERCP pancreatitis: A systematic review by using randomized, controlled trials","volume":"81","author":"Kochar","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.gie.2007.06.065","article-title":"Infection after ERCP, and antibiotic prophylaxis: A sequential quality-improvement approach over 11 years","volume":"67","author":"Cotton","year":"2008","journal-title":"Gastrointest. Endosc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.gie.2008.10.039","article-title":"Risk factors for complications after ERCP: A multivariate analysis of 11,497 procedures over 12 years","volume":"70","author":"Cotton","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1111\/j.1572-0241.2007.01279.x","article-title":"Incidence rates of post-ERCP complications: A systematic survey of prospective studies","volume":"102","author":"Andriulli","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1111\/j.1572-0241.2001.03594.x","article-title":"Complications of diagnostic and therapeutic ERCP: A prospective multicenter study","volume":"96","author":"Masci","year":"2001","journal-title":"Am. J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1056\/NEJM199609263351301","article-title":"Complications of endoscopic biliary sphincterotomy","volume":"335","author":"Freeman","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.hbpd.2018.01.002","article-title":"Risk factor analysis of post-ERCP cholangitis: A single-center experience","volume":"17","author":"Chen","year":"2018","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.gie.2015.05.018","article-title":"A prospective study of the risk of bacteremia in directed cholangioscopic examination of the common bile duct","volume":"83","author":"Othman","year":"2016","journal-title":"Gastrointest. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1067\/mge.2001.113381","article-title":"Unilateral versus bilateral endoscopic hepatic duct drainage in patients with malignant hilar biliary obstruction: Results of a prospective, randomized, and controlled study","volume":"53","author":"Galloro","year":"2001","journal-title":"Gastrointest. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1055\/s-0032-1325677","article-title":"Risk factors for complications of ERCP in primary sclerosing cholangitis","volume":"44","author":"Ismail","year":"2012","journal-title":"Endoscopy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/j.1432-2277.2009.00974.x","article-title":"Antimicrobial prophylaxis in liver transplant patients--a multicenter survey endorsed by the European Liver and Intestine Transplant Association","volume":"23","author":"Vandecasteele","year":"2010","journal-title":"Transpl. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1016\/j.dld.2018.05.014","article-title":"Significant infections in liver transplant recipients undergoing endoscopic retrograde cholangiography are few and unaffected by prophylactic antibiotics","volume":"50","author":"Kohli","year":"2018","journal-title":"Dig. Liver Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"526","DOI":"10.4103\/jmas.jmas_272_21","article-title":"Endoscopic retrograde cholangiopancreaticography-related complications\u2014Experience from tertiary care teaching centre over half a decade","volume":"18","author":"Dahale","year":"2022","journal-title":"J. Minim. Access Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.gie.2014.08.008","article-title":"Antibiotic prophylaxis for GI endoscopy","volume":"81","author":"Khashab","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/ueg2.12186","article-title":"Endoscopic retrograde cholangiopancreatography-related adverse events in Korea: A nationwide assessment","volume":"10","author":"Jang","year":"2022","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1111\/den.14225","article-title":"Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis","volume":"34","author":"Fujita","year":"2022","journal-title":"Dig. Endosc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/0016-5085(91)90091-X","article-title":"Risk factors for septicemia following endoscopic biliary stenting","volume":"101","author":"Motte","year":"1991","journal-title":"Gastroenterology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1007\/s00464-007-9711-0","article-title":"Severe and fatal complications after ERCP: Analysis of 2555 procedures in a single experienced center","volume":"22","author":"Salminen","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"718","DOI":"10.4253\/wjge.v14.i11.718","article-title":"Antibiotic prophylaxis to prevent complications in endoscopic retrograde cholangiopancreatography: A systematic review and meta-analysis of randomized controlled trials","volume":"14","author":"Merchan","year":"2022","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_21","first-page":"368","article-title":"Performance and applicability of a first generation single-use duodenoscope: A single-center cohort study","volume":"35","author":"Persyn","year":"2022","journal-title":"Ann. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1055\/a-1075-4080","article-title":"ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"52","author":"Dumonceau","year":"2020","journal-title":"Endoscopy"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"259","DOI":"10.14740\/gr1391","article-title":"The Incidence of Endoscopic Retrograde Cholangiopancreatography-Related Complications in Patients With Liver Transplant: A Meta-Analysis and Systematic Review","volume":"14","author":"Alomari","year":"2021","journal-title":"Gastroenterol. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s11894-003-0084-9","article-title":"Understanding risk factors and avoiding complications with endoscopic retrograde cholangiopancreatography","volume":"5","author":"Freeman","year":"2003","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Wobser, H., Gunesch, A., and Klebl, F. (2017). Prophylaxis of post-ERC infectious complications in patients with biliary obstruction by adding antimicrobial agents into ERC contrast media- a single center retrospective study. BMC Gastroenterol., 17.","DOI":"10.1186\/s12876-017-0570-4"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/MPA.0b013e318189fl6d","article-title":"Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: A meta-analysis","volume":"38","author":"Bai","year":"2009","journal-title":"Pancreas"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1055\/s-1999-153","article-title":"Meta-analysis of antibiotic prophylaxis in endoscopic retrograde cholangiopancreatography (ERCP)","volume":"31","author":"Harris","year":"1999","journal-title":"Endoscopy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1055\/s-2007-1012830","article-title":"Antibiotic prophylaxis of infectious complications with endoscopic retrograde cholangiopancreatography. A randomized controlled study","volume":"22","author":"Sauter","year":"1990","journal-title":"Endoscopy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1177\/1457496914529274","article-title":"Post-endoscopic retrograde cholangiopancreaticography complications in liver transplanted patients, a single-center experience","volume":"104","author":"Ambrus","year":"2015","journal-title":"Scand. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1093\/clinids\/11.6.954","article-title":"Risk of infectious complications in patients taking glucocorticosteroids","volume":"11","author":"Stuck","year":"1989","journal-title":"Rev. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/art.21705","article-title":"Glucocorticoid use, other associated factors, and the risk of tuberculosis","volume":"55","author":"Jick","year":"2006","journal-title":"Arthritis Rheum."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1086\/514340","article-title":"Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: A matched case-control study","volume":"44","author":"Peleg","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"303","DOI":"10.15403\/jgld-212","article-title":"Multidrug-Resistant Bacteria and Disease Progression in Patients with End-Stage Liver Disease and after Liver Transplantation","volume":"28","author":"Friedrich","year":"2019","journal-title":"J. Gastrointest. Liver Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/cid\/ciab427","article-title":"Molecular Epidemiology, Natural History, and Long-Term Outcomes of Multidrug-Resistant Enterobacterales Colonization and Infections Among Solid Organ Transplant Recipients","volume":"74","author":"Shields","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1001\/jama.2014.12720","article-title":"New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes","volume":"312","author":"Epstein","year":"2014","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1002\/jhbp.129","article-title":"Antibiotic prophylaxis for endoscopic retrograde chlangiopancreatography increases the detection rate of drug-resistant bacteria in bile","volume":"21","author":"Minami","year":"2014","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3474","DOI":"10.1007\/s10620-018-5263-5","article-title":"Evaluation of Biliary Bacterial Resistance in Patients with Frequent Biliary Instrumentation, One Size Does Not Fit All","volume":"63","author":"Masadeh","year":"2018","journal-title":"Dig. Dis. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1438\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:07:58Z","timestamp":1760105278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/5\/1438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":37,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["jcm13051438"],"URL":"https:\/\/doi.org\/10.3390\/jcm13051438","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,1]]}}}