Routine drainage for orthotopic liver transplantation

Surgeons insert a drain (a tube emerging from the tummy to the exterior) with an intention of detecting, monitoring, or prevention of any blood or body fluids collection in the abdominal cavity after the operation. This is called abdominal drain. While this is standard practice in patients undergoing liver transplantation, some recent studies have suggested that routine use of an abdominal drainage may not be useful and even can be harmful. We searched the medical literature to find an answer to the question as to whether it is beneficial or harmful to use abdominal drains routinely in patients undergoing liver transplantation.

We were unable to identify randomised trials, which are studies that have the highest potential to give an accurate answer. We were unable to locate any such trial. We identified three non-randomised studies. All these studies were at high risk of giving inaccurate answers to the question. The results in these studies were conflicting. This highlights the need for well-designed randomised trials. Such trials should be very well designed so as to give the correct answer to the question. Such trials should also include sufficient patients to decrease the play of chance in finding the correct answer. The results from non-randomised studies show that the question of routine abdominal drainage in liver transplantation is an important clinical research question. Currently, there is no evidence to conclude whether routine abdominal drainage is useful or harmful in patients undergoing orthotopic liver transplantation.

Authors' conclusions: 

There is currently no evidence to conclude whether routine abdominal drainage is useful or harmful in patients undergoing orthotopic liver transplantation. Evidence from non-randomised studies of high risk of bias showed conflicting results on the impact of routine drainage in orthotopic liver transplantation on serious adverse events, showing that this question is an important clinical research question. Well-designed randomised clinical trials with adequate sample size to decrease systematic errors and to decrease random errors are necessary.

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Background: 

Routine use of abdominal drainage in patients undergoing liver transplantation is controversial.

Objectives: 

To assess the benefits and harms of routine abdominal drainage after orthotopic liver transplantation versus no drainage and to address different drain types.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and the MetaRegister of Controlled Trials until March 2011 to identify the randomised trials.

Selection criteria: 

We planned to include only randomised clinical trials (irrespective of language, blinding, or publication status) addressing this issue.

Data collection and analysis: 

Two authors identified the trials for inclusion independently. Two authors planned to collect the data independently. We planned to analyse the data with both the fixed-effect and the random-effects model using RevMan Analysis. For each outcome we planned to calculate the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis whenever possible.

Main results: 

We did not identify any randomised clinical trials addressing this issue.

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