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Orthotopic Liver Transplantation: T-Tube or Not T-Tube? Systematic Review and Meta-Analysis of Results

Background. The purpose of this study was to compare outcomes after duct-to-duct anastomoses with or without biliary T-tube in orthotopic liver transplantation. Methods. We pooled the outcomes of 1027 patients undergoing choledocho-choledochostomy with or without T-tube in 9 of 46 screened trials by means of fixed or random effects models. Results. The “without T-tube” and “with T-tube” groups had equivalent outcomes for: anastomotic bile leaks or fistulas, choledocho-jejunostomy revisions, dilatation and stenting, hepatic artery thromboses, retransplantation, and mortality due to biliary complications. The “without T-tube” group had better outcomes when considering “fewer episodes of cholangitis,” “fewer episodes of peritonitis,” and showed a favorable trend for “overall biliary complications.” Although the “with T-tube” group showed superior result for “anastomotic and nonanastomotic strictures,” the incidence of interventions was not diminished. Conclusions. Our systematic review and meta analysis favor the abandonment of T-tubes in orthotopic liver transplantation.