The role of T-tubes and abdominal drains on short-term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations

Marit Kalisvaart, Jeroen de Jonge, Peter Abt, Susan Orloff, Paolo Muiesan, Sander Florman, Michael Spiro, Dimitri Aristotle Raptis, Bijan Eghtesad

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T-tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation. Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel to assess the potential risks and benefits of T-tubes and intra-abdominal drainage in liver transplantation (CRD42021243036). Results: Of the 2996 screened records, 33 studies were included in the systematic review, of which 29 (6 RCT) assessed the use of T-tubes and 4 regarding surgical drains. Although some studies reported less strictures when using a T-tube, there was a trend towards more biliary complications with T-tubes, mainly related to biliary leakage. Due to the small number of studies, there was a paucity of evidence on the effect of abdominal drains with no clear benefit for or against the use of drainage. However, one study investigating the open vs. closed circuit drains found a significantly higher incidence of intra-abdominal infections when open-circuit drains were used. Conclusions: Due to the potential risk of biliary leakage and infections, the routine intraoperative insertion of T-tubes is not recommended (Level of Evidence moderate - very low; grade of recommendation strong). However, a T-tube can be considered in cases at risk for biliary stenosis. Due to the scant evidence on abdominal drainage, no change in clinical practice in individual centers is recommended. (Level of Evidence very low; weak recommendation). This article is protected by copyright. All rights reserved.

Original languageEnglish (US)
JournalClinical Transplantation
DOIs
StateAccepted/In press - 2022

Keywords

  • abdominal drainage
  • biliary complications
  • biliary leakage
  • biliary strictures
  • complications
  • liver transplantation
  • outcomes
  • T-tubes

ASJC Scopus subject areas

  • Transplantation

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