Journal
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
Volume 15, Issue 10, Pages 1201-1212Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/17474124.2021.1903874
Keywords
Orthotopic liver transplantation; biliary tract reconstruction; T-tube; biliary complication; meta-analysis
Categories
Funding
- Fundamental Research Funds for the Central Universities [2020JBKYZX001, LZUJBKY-2020-KB20]
- Key Laboratory of Evidence Based Medicine and Knowledge Translation Foundation of Gansu Province [GSEBMKT-2021KFKT03]
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The use of T-tube in OLT remains controversial, with higher biliary complications in the T-tube group but higher odds of biliary strictures in the no T-tube group. T-tube can be considered for high-risk patients.
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.
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