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

Sotiropoulos, Georgios C.; Sgourakis, George; Radtke, Arnold; Molmenti, Ernesto P.; Goumas, Konstantinos; Mylona, S.; Fouzas, I.; Karaliotas, Constantine; Lang, Hauke

doi:10.1097/tp.0b013e3181a5cf3f

Cited by 82 publications

(60 citation statements)

References 21 publications

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“…Considering the significant heterogeneity, we suggest that both groups have an equal risk of cholangitis. Our findings are in contrast to the conclusions drawn from the previous meta-analyses concerning overall biliary complications and cholangitis (Sotiropoulos et al, 2009). Our analysis added three new studies: one was an RCT with a high Jadad score and the other two were comparative studies, among which one had selection bias and the other had five cases of living donor liver transplantation in the group without T-tube.…”

Section: Discussioncontrasting

confidence: 57%

“…However, this may be partly due to the presence of biliary complications other than those considered in our study. Peritonitis and hepatic artery thrombosis were evaluated in a previous metaanalysis (Sotiropoulos et al, 2009), which showed that peritonitis had a higher incidence rate in the group with a T-tube, while hepatic artery thrombosis did not significantly differ between the two groups. Since the new studies did not provide data about these complications, we did not include them in this study.…”

Section: Discussionmentioning

confidence: 99%

“…In order to evaluate whether using a T-tube in CCS is associated with complications, a systematic review was conducted by Sotiropoulos et al (2009). They found that CCS without a T-tube has better outcomes with lower incidences of cholangitis and peritonitis, and fewer overall biliary complications, favoring the abandonment of the T-tube in OLT.…”

Section: Introductionmentioning

confidence: 99%

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Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

Huang

Jiang

2011

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation. Methods: Randomized control trials (RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library, MEDLINE (1966/1-2010/4), Scopus (1980/1-2010/4), ClinicalTrials.gov (2010/4), the Cochrane Hepato-Biliary Group Controlled Trials Register, and the Cochrane Central Register of Controlled Trials. Studies and data were extracted and assessed independently. Dichotomous outcomes were reported as odds ratios (ORs) and weighted mean difference with 95% confidence intervals (CI). Results: Five RCTs and eight comparative studies with a total of 1 608 subjects were identified. The data showed that the operation with T-tube had better outcomes for duct stenosis (P=0.01, OR=0.45, 95% CI 0.24-0.85). The operations with or without T-tube had equivalent outcomes as follows: overall biliary complications (P=0.85, OR=1.15, 95% CI 0.28-4.72), bile leaks (P=0.38, OR=0.75, 95% CI 0.39-1.42), and cholangitis (P=0.24, OR=4.64, 95% CI 0.36-60.62). These results were strengthened by the analysis of all thirteen non-randomized and randomized studies. Conclusions: Our systematic review and meta-analysis suggest that the insertion of a T-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

Huang

Jiang

2011

J. Zhejiang Univ. Sci. B

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“…Thus, comparison of the pure rate of bile leaks is misleading, but one has to consider their clinical severity. However this is not the case in most (meta-)analyses (29,30). Moreover, leaks after T-tube removal lack severity and are easy to treat, since they do not appear in the critical phase early after LT.…”

Section: T-tube: Risk or Benefit?mentioning

confidence: 95%

“…After final placement, the opening is further narrowed by PDS 5/0 stitches. Two metaanalyzes found an increased risk for bile leaks if a T-tube is used (28,29). A newer metaanalysis found no overall differences in biliary morbidity but a lower rate of biliary strictures in patients with T-tubes (30).…”

Section: T-tube: Risk or Benefit?mentioning

confidence: 99%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Biliary Complications following Liver Transplantation

Dries

Verdonk

Porte

2012

Medical Care of the Liver Transplant Patient

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

Abstract: Our systematic review and meta analysis favor the abandonment of T-tubes in orthotopic liver transplantation.

Cited by 82 publications

References 21 publications

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications following Liver Transplantation

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