title: Liver transplantation without abdominal drainage.
abstract: This observational cohort compared 70 consecutive liver transplantations (OLT) with no intra-abdominal drain and 70 control subjects C with an intra-abdominal drain who were operated immediately prior to them. We sought to assess the impact of abdominal drainage on the diagnosis and prevention of early postoperative complications of hemoperitoneum, reinterventions, biliary leaks or percutaneous drainage. We assessed variables related to the recipient (age, indication, pretransplant ascites, body mass index, Model for End-stage Liver Disease score, and rejection episodes, to the donor (age, steatosis and, ischemia time) as well as intra- and postoperative factors (surgery time, blood product use, and coagulopathy). The endpoint was defined as the need for a reintervention, postoperative paracentesis, appearance/drainage of collections, as well as lengths of hospital and intensive care unit (ICU) stays. Postoperative ICU and in-hospital stay were similar between the groups (3.6 versus 3.7 days and 12 versus 14 days respectively). Six patients in the drainage group were reoperated due to hemoperitoneum, whereas it was one in the cohort without drainage. Three patients presented a biliary fistula, two in the group without drainage, and one in the drainage group. One patient in the drainage group required percutaneous drainage of an intra-abdominal collection. The need for postoperative paracentesis was greater among the group without drainage (30% versus 6%; P < .008) and among those with a preoperative ascites > 1000 mL (38%). Patients with drainage displayed a greater incidence of perihepatic hematomas upon ultrasound (50% versus 22%, P < .008) and required more postoperative blood products, especially plasma (P < .01). In conclusion, OLT without intra- abdominal drainage is safe and does not increase morbidity. It seems likely that drainage may be responsible for intra-abdominal hematomas and greater consumption of blood products.
authors.affiliation: Liver Transplant Unit, University Hospital Carlos Haya, Malaga, Spain. jlfaguilar@telefonica.net
authors.forename: J L
authors.initials: JL
authors.lastname: Fernandez-Aguilar
authors.forename: M A
authors.initials: MA
authors.lastname: Suarez-Muñoz
authors.forename: B
authors.initials: B
authors.lastname: Sanchez-Perez
authors.forename: E
authors.initials: E
authors.lastname: Gamez Cordoba
authors.forename: Y
authors.initials: Y
authors.lastname: Pulido Roa
authors.forename: J
authors.initials: J
authors.lastname: Aranda Narvaez
authors.forename: A
authors.initials: A
authors.lastname: Perez Daga
authors.forename: C
authors.initials: C
authors.lastname: Montiel Casado
authors.forename: A
authors.initials: A
authors.lastname: Gonzalez Sanchez
authors.forename: J
authors.initials: J
authors.lastname: Santoyo Santoyo
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D001658:Biliary Fistula / Q000209:etiology / Q000628:therapy; D016913:Blood Component Transfusion; D016022:Case-Control Studies; D004322:Drainage; D005260:Female; D006406:Hematoma / Q000209:etiology / Q000628:therapy; D006465:Hemoperitoneum / Q000209:etiology / Q000628:therapy; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019152:Paracentesis; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome