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.
T-tubes
abdominal drainage
biliary complications
biliary leakage
biliary strictures
complications
liver transplantation
outcomes
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
Oct 2022
Oct 2022
Historique:
received:
13
01
2022
accepted:
20
04
2022
pubmed:
22
5
2022
medline:
15
12
2022
entrez:
21
5
2022
Statut:
ppublish
Résumé
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. 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). 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. 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).
Sections du résumé
BACKGROUND
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
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
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
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).
Identifiants
pubmed: 35596705
doi: 10.1111/ctr.14719
pmc: PMC10078006
doi:
Types de publication
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14719Investigateurs
Ioannis Kostakis
(I)
Dimitrios Schizas
(D)
Claus Niemann
(C)
Joerg-Matthias Pollok
(JM)
Marina Berenguer
(M)
Pascale Tinguely
(P)
Informations de copyright
© 2022 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.
Références
Transplantation. 2009 Jun 15;87(11):1672-80
pubmed: 19502959
Clin Transplant. 2007 Jul-Aug;21(4):548-53
pubmed: 17645718
Expert Rev Gastroenterol Hepatol. 2015 Apr;9(4):529-38
pubmed: 25583036
AJR Am J Roentgenol. 1985 Jan;144(1):127-33
pubmed: 3880623
Transplant Proc. 2009 Oct;41(8):3126-30
pubmed: 19857693
J Clin Epidemiol. 2013 Jul;66(7):719-25
pubmed: 23312392
Scand J Gastroenterol. 1996 May;31(5):506-11
pubmed: 8734350
Transplant Proc. 2002 Jun;34(4):1211-5
pubmed: 12072318
Liver Transpl Surg. 1997 Jul;3(4):374-8
pubmed: 9346766
Liver Transpl. 2010 Jun;16(6):705-17
pubmed: 20517904
Transplant Proc. 2004 May;36(4):951-2
pubmed: 15194330
Clin Transplant. 2004 Dec;18(6):647-53
pubmed: 15516238
Evid Based Med. 2017 Jun;22(3):85-87
pubmed: 28320705
Transpl Int. 1996;9 Suppl 1:S185-7
pubmed: 8959822
Ann Surg. 2004 Feb;239(2):194-201
pubmed: 14745327
J Zhejiang Univ Sci B. 2011 May;12(5):357-64
pubmed: 21528489
World J Gastroenterol. 2021 Apr 14;27(14):1507-1523
pubmed: 33911471
Transplant Proc. 2007 Dec;39(10):3251-6
pubmed: 18089365
Expert Rev Gastroenterol Hepatol. 2021 Oct;15(10):1201-1213
pubmed: 33720798
Ann Surg. 2013 Jul;258(1):21-9
pubmed: 23426348
Transplant Proc. 2012 Jul-Aug;44(6):1550-3
pubmed: 22841210
Am J Transplant. 2013 Feb;13(2):253-65
pubmed: 23331505
Liver Transpl. 2019 Feb;25(2):323-335
pubmed: 30329213
Transplant Proc. 2016 Nov;48(9):3003-3005
pubmed: 27932131
Acta Med Port. 2017 Feb 27;30(2):122-126
pubmed: 28527479
Curr Opin Organ Transplant. 2014 Jun;19(3):209-16
pubmed: 24752062
Transplant Proc. 2019 Jan - Feb;51(1):44-49
pubmed: 30736977
Ann Surg. 2001 Mar;233(3):432-7
pubmed: 11224633
Transplant Proc. 1997 Nov;29(7):2849-50
pubmed: 9365588
Aust N Z J Surg. 1999 Oct;69(10):717-22
pubmed: 10527348
Clin Transplant. 2022 Oct;36(10):e14719
pubmed: 35596705
Transplant Proc. 2012 Sep;44(7):2098-9
pubmed: 22974922
Ann Surg. 2009 Nov;250(5):766-71
pubmed: 19809299
Transplant Proc. 2005 Nov;37(9):3922-3
pubmed: 16386585
Transplant Proc. 1997 Feb-Mar;29(1-2):564-5
pubmed: 9123131
Crit Care Med. 2008 Apr;36(4 Suppl):S179-86
pubmed: 18382191
Transplantation. 1994 Feb;57(3):402-4
pubmed: 8108875
Transplantation. 1996 Jan 27;61(2):258-61
pubmed: 8600634
Am J Transplant. 2001 Jul;1(2):157-61
pubmed: 12099364
Eur J Med Res. 2015 Aug 21;20:66
pubmed: 26293656
J Clin Epidemiol. 2013 Jul;66(7):726-35
pubmed: 23570745
J Gastrointest Surg. 2019 Mar;23(3):529-537
pubmed: 30097968
Transpl Int. 1996;9(4):392-5
pubmed: 8819276
Surgery. 2017 Nov;162(5):1101-1111
pubmed: 28859949
Ann Surg. 1993 Dec;218(6):748-53
pubmed: 8257225
Cochrane Database Syst Rev. 2011 Jun 15;(6):CD008399
pubmed: 21678376
Transplant Proc. 2007 Nov;39(9):2785-7
pubmed: 18021987
Ann Transplant. 2001;6(2):24-8
pubmed: 11803614
J Am Coll Surg. 2018 Apr;226(4):484-494
pubmed: 29360615
Langenbecks Arch Surg. 2015 Oct;400(7):813-9
pubmed: 26341224
Front Surg. 2021 Jul 12;8:690436
pubmed: 34322515
Transplant Proc. 2012 Nov;44(9):2542-4
pubmed: 23146448
World J Gastroenterol. 2013 May 21;19(19):2841-6
pubmed: 23704818
Transplant Proc. 2010 Dec;42(10):4154-7
pubmed: 21168650
Dig Surg. 2008;25(4):245-57
pubmed: 18628624
Postgrad Med J. 2009 Mar;85(1001):119-23
pubmed: 19351636
Liver Transpl. 2009 Jan;15(1):96-101
pubmed: 19109839
J Clin Epidemiol. 2009 Oct;62(10):1006-12
pubmed: 19631508
J Clin Epidemiol. 2011 Apr;64(4):383-94
pubmed: 21195583