Use of stepwise versus straightforward clamping of biliary drainage tubes after living-donor liver transplantation: a prospective, randomized trial.

BACKGROUND/PURPOSE There has been no report describing the optimal clamping method for biliary drainage tubes in living-donor liver transplantation (LDLT), although biliary splinting and drainage plays an important role in this procedure. METHODS When performing LDLT, we generally use a 2-mm drainage tube for the splint at the biliary anastomosis, and externalize it through the lower common bile duct. In the present study, when the serum levels of total bilirubin were lower than 5 mg/dl, and negativity for biliary complications and good passage of contrast media to the duodenum were confirmed, the drainage tubes were clamped. To determine the optimal clamping method, patients were randomly divided into two groups; those whose drainage tubes were subjected to stepwise clamping for 3, 6, 12, and 24 h per day (n = 20), and those whose drainage tubes were subjected to straightforward clamping (n = 20). RESULTS The results of liver function tests and rates of clamping failure were not different between the two groups after the different clamping methods were used. CONCLUSIONS Straightforward clamping could be a simple and reasonable method to close a biliary drainage tube after LDLT.