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*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
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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 (six RCTs) assessed the use of T-tubes and four regarding surgical drains. Although some studies reported less strictures when using a T-tube, there was a trend toward 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).

Original languageEnglish
Article numbere14719
JournalClinical Transplantation
Volume36
Issue number10
Early online date21 May 2022
DOIs
Publication statusPublished - Oct 2022

Bibliographical note

Funding Information:
This manuscript was prepared for the ERAS4OLT.org Consensus Conference 2022, which is partially funded by the International Liver Transplant Society (ILTS).

Publisher Copyright:
© 2022 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.

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