T-tube or no T-tube for biliary tract reconstruction in orthotopic liver transplantation: an updated systematic review and meta-analysis

ABSTRACT

Objectives: Biliary tract reconstruction with or without T-tube is commonly used in orthotopic liver transplantation (OLT). However, the efficacy and safety of T-tube usage remain controversial. This meta-analysis was conducted to assess the latest evidence of clinical outcomes.

Methods: Embase, Cochrane Library, PubMed, and Web of Science were systematically searched from inception to 20 January 2021 for eligible studies. The analyses were performed using Review Manager and Stata.

Results: A total of 24 trials involving 3320 participants were included in the meta-analysis. Compared with the no T-tube group, there was a higher incidence of overall biliary complications (OR:1.54; 95%CI, 1.06–2.24; P = 0.02), bile leaks (OR:2.34; 95%CI,1.57–3.48; P < 0.0001), cholangitis (OR:2.78; 95%CI,1.19–6.51; P = 0.002), and longer cold ischemia time (MD:22.27; 95%CI,0.80–43.74; P = 0.04) in the T-tube group. Furthermore, the no T-tube group had significantly higher odds of biliary strictures than the T-tube group (OR:0.60; 95%CI, 0.47–0.78; P = 0.0001).

Conclusion: T-tube is still not routinely recommended, but is a good choice for OLT patients at high risk of biliary strictures. Notably, the higher rate of biliary complications in the T-tube group did not translate into an increase in endoscopic or re-operative interventions.

KEYWORDS:

• Orthotopic liver transplantation
• biliary tract reconstruction
• T-tube
• biliary complication
• meta-analysis

Acknowledgments

We thank Professor Kehu Yang from the Evidence-Based Medicine Center of Lanzhou University for guidance.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. And all authors declare that they have no conflict of interest.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

G.Tiankang, and Y.Kehu were involved in the conception and design; S.Shaoming, L.Tingting, Y.Wenwen, G.Shivi, L.Caining, F.Lufang, and T.Hongwei were involved in the analysis and interpretation of data; S.Shaoming, and L.Tingting were involved in the drafting of the paper or revising; G.Tiankang, and Y.Kehu were involved the final approval of the version to be published; and that all authors agree to be accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This research was supported by the Fundamental Research Funds for the Central Universities (2020JBKYZX001, LZUJBKY-2020-KB20); the Key Laboratory of Evidence Based Medicine and Knowledge Translation Foundation of Gansu Province (Grant no. GSEBMKT-2021KFKT03).