title: Abdominal drains in liver transplantation: useful tool or useless dogma? A matched case-control study.
abstract: On the basis of the growing evidence from randomized trials that routine prophylactic drainage is unnecessary in liver surgery or even harmful in chronic liver disease, we challenged the concept of prophylactic drainage in orthotopic liver transplantation (OLT). Since September 2006, we omitted drains in every patient who underwent OLT, regardless of the procedure. Thirty-five cadaveric OLTs were performed during a 12-month period. These patients were matched 1:2 with 70 patients who had prophylactic drainage after OLT according to donor/recipient age, recipient gender, recipient body mass index, and Model for End-Stage Liver Disease (MELD) score. Endpoints were postoperative morbidity, in-hospital mortality, intensive care unit (ICU), and hospital stay. Complications were graded according to a therapy-oriented classification (grades I-V). Both groups (no drainage, n = 35; drainage, n = 70) were comparable in terms of median donor age (47.5 versus 51.0 years), recipient age (50.6 versus 52.0 years), MELD score (18 versus 14), and body mass index (25.3 versus 26 kg/m(2)). Because of the increasing shortage of organs, more marginal grafts were used in the recent period (ie, no-drainage group): 49% (17/35) versus 27% (19/70; P = 0.04). Major complications were not different between groups: grade 3a (endoscopic/radiological intervention) in 20% (7/35) versus 16% (11/70; not significant), grade 3b (surgical intervention) in 23% (8/35) versus 17% (12/70; not significant), grade 4a (ICU therapy, intermittent hemodialysis) in 34% (12/35) versus 21% (15/70; not significant), grade 4b (multiorgan failure) in 14% (5/35) versus 10% (7/70; not significant), and grade 5 (death) in 6% (2/35) versus 7% (5/70; not significant). This matched case study challenges the dogma of prophylactic drainage after OLT. A no-drain strategy provided no disadvantages despite increased use of extended criteria donors in the no-drainage group. Prophylactic drainage appears unnecessary on a routine basis.
authors.affiliation: Swiss Hepato-Pancreatico-Biliary and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: de Rougemont
authors.forename: Philipp
authors.initials: P
authors.lastname: Dutkowski
authors.forename: Markus
authors.initials: M
authors.lastname: Weber
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery; D008107:Liver Diseases / Q000601:surgery / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome