Selective Indication of T-Tube in Liver Transplantation: Prospective Validation of the Results of a Randomized Controlled Trial

López‐Andújar, Rafael; Maupoey, Javier; Escrig-Sos, Javier; Granero, P.; Vila, Juan J.; Pradas, V. Ibáñez; Bosca, A. Ramirez; García‐Eliz, María; Benlloch, Salvador; Orbis, J.; Montalvá, Eva

doi:10.1016/j.transproceed.2018.03.133

Cited by 10 publications

(9 citation statements)

References 25 publications

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“…Reports of increased complications resulted in large‐scale avoidance of T‐tubes in many programs 64,66 . However, more recent studies utilizing advanced protocols and equipment have shown no difference in the rate of development of biliary complications 71,72 …”

Section: Discussionmentioning

confidence: 99%

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Are short‐term complications associated with poor allograft and patient survival after liver transplantation? A systematic review of the literature and expert panel recommendations

Alconchel

Tinguely

Frola

et al. 2022

Clinical Transplantation

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Background: Maximizing patient and allograft survival after liver transplant (LT) is important from both a patient care and organ utilization perspective. Although individual studies have addressed the effects of short-term post-LT complications on a limited scale, there has not been a systematic review of the literature formally assessing the potential effects of early complications on long-term outcomes.Objectives: To identify whether short-term complications after LT affect allograft and overall survival, to identify short-term complications of particular clinical interest and significance, and to provide recommendations to improve post-LT graft and patient survival.Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.Methods: A systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Results:The literature review and analysis provided show that short-term complications have a large impact on allograft and patient survival after LT. The complications with the strongest effect on survival are acute kidney injury (AKI), biliary complications, and early allograft dysfunction (EAD). Conclusion: This panel recommends taking measures to reduce the risk and incidence of short-term complications post-LT. Clinicians should pay particular attention to preventing or ameliorating AKI, biliary complications, and EAD (Quality of evidence; Moderate | Grade of Recommendation; Strong).

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Section: Discussionmentioning

confidence: 99%

“…64,66 However, more recent studies utilizing advanced protocols and equipment have shown no difference in the rate of development of biliary complications. 71,72…”

Section: Biliary Complicationsmentioning

confidence: 99%

Are short‐term complications associated with poor allograft and patient survival after liver transplantation? A systematic review of the literature and expert panel recommendations

Alconchel

Tinguely

Frola

et al. 2022

Clinical Transplantation

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“…Despite a significant heterogeneity among LT centers, an overall trend toward limiting the use of T-tube in LT has been recorded in recent years [ 19 , 20 ]. Nonetheless, in case of biliary reconstruction with high technical complexity (size discrepancy between graft and recipient bile duct, very small bile ducts) or high risk of bile leakage, the use of a device for biliary tutoring and decompression may still be required [ 19 , 31 ]. Thus, strategies to reduce the potential functional morbidity of T-tube should be further explored and implemented in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

et al. 2022

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The liver–gut axis has been identified as crucial mediator of liver regeneration. Thus, the use of a T-tube in liver transplantation (LT), which interrupts the enterohepatic bile circulation, may potentially have a detrimental effect on the early allograft functional recovery. We retrospectively analyzed a cohort of 261 patients transplanted with a whole liver graft, with a duct-to-duct biliary anastomosis, who did not develop any surgical complication within postoperative day 14. Early allograft dysfunction (EAD) was defined according to the criteria of Olthoff et al. (EAD-O), and graded according to the Model for Early Allograft Function (MEAF) score. EAD-O developed in 24.7% of recipients and the median MEAF score was 4.0 [interquartile range 2.9–5.5]. Both MEAF and EAD predicted 90-day post-LT mortality. A T-tube was used in 49.4% of cases (n = 129). After a propensity score matching for donor age, cold and warm ischemia time, donor risk index, balance of risk score, Child–Pugh class C, and MELD score, the T-tube group showed a significantly higher prevalence of EAD-O and value of MEAF than the no-T-tube group (EAD-O: 29 [34.1%] vs 16 [19.0%], p = 0.027; MEAF 4.5 [3.5–5.7] vs 3.7 [2.9–5.0], p = 0.014). In conclusion, T-tube use in LT may be a risk factor for EAD and higher MEAF, irrespective of graft quality and severity of pre-LT liver disease.

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“…The liver transplant centers selectively utilize a T-tube to perform the choledochocholedochostomy reconstruction (Figure 1) [7]. The T-tube is used in the biliary system to reduce the risk/incidence of biliary complications by mechanically strengthening the anastomosis.…”

Section: T-tube Indication In Oltmentioning

confidence: 99%

“…The prospective cohort study by López-Andújar et al revealed the presence of anastomotic stenosis in 2% of OLT patients with T-tube compared to 12% in those without T-tube [7]. In addition, the resolution of T-tuberelated biliary stenosis was achieved by percutaneous transhepatic cholangiography/endoscopic retrograde cholangiopancreatography-guided biliary prostheses placement and dilatation.…”

Section: Bile Leaks and Stricturesmentioning

confidence: 99%

Biliary Anastomosis Using T-tube Versus No T-tube for Liver Transplantation in Adults: A Review of Literature

Vest¹,

Ciobanu²,

Nyabera³

et al. 2022

Cureus

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The T-tube-directed biliary anastomosis in orthotopic liver transplantation (OLT) aims to minimize preventable biliary complications, including bile leaks and strictures. Biliary complications in patients with OLT increase the risk of morbidity and mortality. This review paper evaluated the current evidence on the routine use of T-tube reconstruction in OLT cases.A review of prospective, retrospective, observational, cohort studies as well as systematic reviews, metaanalyses, review papers, and opinion papers has been conducted to evaluate the therapeutic potential of T tube-based biliary anastomosis in cases of OLT.Our finding showed a bile leak incidence of 16.6% and 6.6% in T-tube and non-T-tube groups, respectively. The results indicated a lower incidence of anastomotic fistulae in the non-T-tube group (0.6%) compared to the T-tube group (4%). The findings negated statistically significant differences in the three-year actuarial survival rates based on biliary anastomosis with and without T-tube intervention (62.5% vs. 69.8%). The studies revealed a 6-11% and 2-11% incidence of cholangitis in OLT patients with T-tube-based reconstruction and those without a T-tube, respectively, and 26% and 20% incidence of total biliary complications in OLT patients with and without T-tube, respectively. In addition, the findings ruled out the influence of a T-tube on the incidence of perioperative complications, endoscopies, and reoperations in OLT cases.The current evidence correlates the increased incidence of bile leaks, cholangitis, and overall biliary complications with the use of a T-tube during OLT. In addition, T-tube-guided reconstruction has no impact on perioperative complications, overall survival, endoscopies, and reoperations in OLT cases.

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Selective Indication of T-Tube in Liver Transplantation: Prospective Validation of the Results of a Randomized Controlled Trial

Cited by 10 publications

References 25 publications

Are short‐term complications associated with poor allograft and patient survival after liver transplantation? A systematic review of the literature and expert panel recommendations

Are short‐term complications associated with poor allograft and patient survival after liver transplantation? A systematic review of the literature and expert panel recommendations

Re-thinking of T-tube use in whole liver transplantation: an analysis on the risk of delayed graft function

Biliary Anastomosis Using T-tube Versus No T-tube for Liver Transplantation in Adults: A Review of Literature

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