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An Italian survey on the use of T-tube in liver transplantation: old habits die hard!
There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397659/ https://www.ncbi.nlm.nih.gov/pubmed/33792888 http://dx.doi.org/10.1007/s13304-021-01019-1 |
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author | Pravisani, Riccardo De Simone, Paolo Patrono, Damiano Lauterio, Andrea Cescon, Matteo Gringeri, Enrico Colledan, Michele Di Benedetto, Fabrizio di Francesco, Fabrizio Antonelli, Barbara Manzia, Tommaso Maria Carraro, Amedeo Vivarelli, Marco Regalia, Enrico Vennarecci, Giovanni Guglielmo, Nicola Cesaretti, Manuela Avolio, Alfonso Wolfango Valentini, Maria Filippa Lai, Quirino Baccarani, Umberto |
author_facet | Pravisani, Riccardo De Simone, Paolo Patrono, Damiano Lauterio, Andrea Cescon, Matteo Gringeri, Enrico Colledan, Michele Di Benedetto, Fabrizio di Francesco, Fabrizio Antonelli, Barbara Manzia, Tommaso Maria Carraro, Amedeo Vivarelli, Marco Regalia, Enrico Vennarecci, Giovanni Guglielmo, Nicola Cesaretti, Manuela Avolio, Alfonso Wolfango Valentini, Maria Filippa Lai, Quirino Baccarani, Umberto |
author_sort | Pravisani, Riccardo |
collection | PubMed |
description | There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated. |
format | Online Article Text |
id | pubmed-8397659 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-83976592021-09-15 An Italian survey on the use of T-tube in liver transplantation: old habits die hard! Pravisani, Riccardo De Simone, Paolo Patrono, Damiano Lauterio, Andrea Cescon, Matteo Gringeri, Enrico Colledan, Michele Di Benedetto, Fabrizio di Francesco, Fabrizio Antonelli, Barbara Manzia, Tommaso Maria Carraro, Amedeo Vivarelli, Marco Regalia, Enrico Vennarecci, Giovanni Guglielmo, Nicola Cesaretti, Manuela Avolio, Alfonso Wolfango Valentini, Maria Filippa Lai, Quirino Baccarani, Umberto Updates Surg Original Article There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated. Springer International Publishing 2021-04-01 2021 /pmc/articles/PMC8397659/ /pubmed/33792888 http://dx.doi.org/10.1007/s13304-021-01019-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Pravisani, Riccardo De Simone, Paolo Patrono, Damiano Lauterio, Andrea Cescon, Matteo Gringeri, Enrico Colledan, Michele Di Benedetto, Fabrizio di Francesco, Fabrizio Antonelli, Barbara Manzia, Tommaso Maria Carraro, Amedeo Vivarelli, Marco Regalia, Enrico Vennarecci, Giovanni Guglielmo, Nicola Cesaretti, Manuela Avolio, Alfonso Wolfango Valentini, Maria Filippa Lai, Quirino Baccarani, Umberto An Italian survey on the use of T-tube in liver transplantation: old habits die hard! |
title | An Italian survey on the use of T-tube in liver transplantation: old habits die hard! |
title_full | An Italian survey on the use of T-tube in liver transplantation: old habits die hard! |
title_fullStr | An Italian survey on the use of T-tube in liver transplantation: old habits die hard! |
title_full_unstemmed | An Italian survey on the use of T-tube in liver transplantation: old habits die hard! |
title_short | An Italian survey on the use of T-tube in liver transplantation: old habits die hard! |
title_sort | italian survey on the use of t-tube in liver transplantation: old habits die hard! |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397659/ https://www.ncbi.nlm.nih.gov/pubmed/33792888 http://dx.doi.org/10.1007/s13304-021-01019-1 |
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