A prospective randomised trial of bile duct reconstruction at liver transplantation: T tube or no T tube?

Vougas, V.; Rela, Mohamed; Gane, Edward; Muiesan, Paolo; Melendez, Hector Vilca; Williams, Roger; Heaton, Nigel

doi:10.1111/j.1432-2277.1996.tb00897.x

Cited by 77 publications

(31 citation statements)

References 12 publications

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“…In view of the high rates of T-tube-related biliary complications, many groups have abandoned the use of the T-tube at whole-organ OLT, which was shown to be safe, efficacious, and cost-effective, as compared to biliary reconstruction over a T-tube [84, 85, 102, 103]. This conforms with the results from two prospective, randomized trials showing no advantage of biliary drainage at whole-organ OLT [86, 88]. The non-operative management of biliary complications following OLT has become standard practice with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.…”

Section: Discussionsupporting

confidence: 54%

“…Many groups have abandoned the use of a T-tube at whole-organ OLT, which has been shown to be safe, efficacious, and cost-effective, as compared to biliary reconstruction over a T-tube [86, 87, 105, 106]. This practice conforms with the results from two prospective, randomized trials showing no advantage of biliary drainage at whole-organ OLT [88, 90]. According to some authors and our own experience, biliary decompression of duct-to-duct anastomosis may be more indicated in partial-liver graft transplantation when it may reduce the risk of both cut surface and anastomotic biliary leaks [25, 32, 43, 45, 63].…”

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 54%

“…Anastomotic strictures that appear early in the postoperative period are usually related to errors in the surgical technique, whereas later onset most likely indicates fibrotic healing due to ischemia at the end of the donor or recipient bile duct [107, 108, 121]. According to some series of whole-organ OLT, they are reported to be more common after hepaticojejunostomy than after direct duct-to-duct anastomosis [5, 8, 13], as well as following duct-to-duct anastomosis in non-T-tube recipients, as compared to the anastomosis over a T-tube (table 5) [9,86,87,88,89,90]. In right lobe living-donor transplants, the incidence of duct-to-duct anastomotic strictures has been consistently higher, as compared to recipients of whole liver grafts [24, 25, 32, 34, 44].…”

Section: Biliary Stricturesmentioning

confidence: 99%

“…A T-tube drainage at OLT has traditionally been used to provide easy access to the biliary tree and lower the pressure in the biliary system, which may be elevated in the case of stenosis at the anastomotic site or due to sphincter of Oddi dysfunction [7, 9, 85]. Additionally it aids monitoring of the quality and output of bile and may reduce the incidence of late anastomotic biliary strictures [9,86,87,88,89,90] (table 5) and the need for their surgical repair [9, 89, 91]. Biliary drains, however, may increase complication rates by frequently observed leaks following bile drain removal, its dislodgement, cholangitis and biliary obstruction [5, 8, 90, 92, 93].…”

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 99%

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Biliary Tract Complications after Liver Transplantation: A Review

Wójcicki¹,

Milkiewicz²,

2008

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Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10–30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.

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Section: Discussionsupporting

confidence: 54%

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 54%

Section: Biliary Stricturesmentioning

confidence: 99%

Section: Use Of T-tube and Biliary Complicationsmentioning

confidence: 99%

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Biliary Tract Complications after Liver Transplantation: A Review

Wójcicki¹,

Milkiewicz²,

2008

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“…Dramatic and faster release of liver enzymes and intracellular electrolytes can be measured and indicate severe cell lysis [46]. Bile production, a reliable parameter for liver function, decreased significantly in the first 3 h [88]. Granulocytes and to a lesser degree platelets were retained in the grafts.…”

Section: Xenogenic Liver Transplantation and Perfusion: Functional Camentioning

confidence: 99%

Organs from Animals for Man

Hammer¹,

Linke²,

Wagner³

et al. 1998

Int Arch Allergy Immunol

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In the following review some of the problems of xenotransplantation shall be discussed, based on the few experimental data available so far and on reports in the literature describing investigations which may be of importance for xenotransplantation. The impact of gravity on the upright posture of man versus almost all other mammals, the dysfunction between enzymes and hormones in different species and the lack of interactions between interleukins, cytokines and vasoactive substances will be taken into consideration. The question must be asked whether different levels of carrier molecules or serum proteins play a role in the physiological network. Even though the development of transgenic animals or other imaginative manipulations may lead to the acceptance of any type of xenografted organ, it has to be established for how long the products of the xenografts are able to act in the multifactorial orchestra. We are far from understanding xenogeneic molecular mechanisms involved in toxicity, necrosis and apoptosis or even reperfusion injury and ischemia in addition to the immediate mechanisms of the hyperacute xenogeneic rejection. Here, cell adhesion, blood clotting and vasomotion collide and bring micro- and macrocirculation to a standstill. All types of xenogeneic immunological mechanisms studied so far were found to have a more serious impact than those seen in allogeneic transplantation. In addition we are now only beginning to understand that so-called immunological parameters in allogeneic mechanisms act also in a true physiological manner in the xenogeneic situation. These molecular mechanisms occur behind the curtain of hyperacute, accelerated, acute or chronic xenograft rejection of which only some folds have been lifted to allow glimpses of part of the total scene. Other obstacles are likely to arise when long-term survival is achieved. These obstacles include retroviral infections, transfer of prions and severe side effects of the massive immunosuppression which will be needed. Moral, ethical and religious concerns are under debate and the species-specific production of proteins of the foreign donor species developed for clinical use suddenly appears to be a greater problem than anticipated.

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