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T-tube or No T-tube in Cadaveric Orthotopic Liver Transplantation: The Eternal Dilemma: Results of a Prospective and Randomized Clinical Trial

López-Andújar, Rafael MD, PhD*; Orón, Eva Montalvá MD, PhD*; Carregnato, Andrés Frangi MD*; Suárez, Fabio Vergara MD*; Herraiz, Angel Moya MD, PhD*; Rodríguez, Fernando San Juan MD*; Carbó, Juan José Vila MD, PhD*; Ibars, Eugenia Pareja MD, PhD*; Sos, Javier Escrig MD, PhD; Suárez, Angel Rubín MD; Castillo, Martín Prieto MD, PhD; Pallardó, José Mir MD, PhD*; De Juan Burgueño, Manuel MD, PhD*

doi: 10.1097/SLA.0b013e318286e0a0
Randomized Controlled Trials

Objective: To compare the incidence and severity of biliary complications due to liver transplantation after choledochocholedochostomy with or without a T-tube in a single-center, prospective, randomized trial.

Summary Background Data: The usefulness of the T-tube for end-to-end biliary anastomosis to reduce the incidence of biliary complications in patients undergoing liver transplantation has been controversial.

Methods: A per-protocol analysis was designed for liver recipients, who were randomly assigned to choledochocholedochostomy with (n = 95) or without (n = 92) a T-tube.

Results: The overall biliary complication rate was 22.5% (n = 42), with no difference between groups (P = 0.35). The majority (66.7%) of complications in the T-tube group were types I and II, whereas 50% were type IIIa and 44% were type IIIb in the non–T-tube group (P < 0.0001). Fewer anastomotic strictures were found in the T-tube group (n = 2, 2.1%) than in the non–T-tube group (n = 13, 14.1%; P = 0.002). No difference in anastomotic biliary leakage was observed between groups. Biliary complication–free survival rates showed that complications appeared earlier in the T-tube group. Graft and patient survival rates were similar in both groups.

Conclusions: Complications in the T-tube group were less severe and required less aggressive treatment. The incidence of anastomotic strictures was higher in patients with no T-tube. We recommend conducting choledochocholedochostomy with a rubber T-tube during liver transplantation in risky anastomosis and when the bile duct diameter is less than 7 mm.

This study is registered at http://www.clinicaltrials.gov: Clinical trial ID# NCT01546064.

This study presents a single-center, prospective randomized trial to describe biliary complications on liver transplantation, depending on T-tube use. Severe complications were more frequent in the non-T-tube group (P < 0.0001), with fewer anastomosis strictures in the T-tube group (P = 0.002). We recommend the use of a rubber T-tube, mainly with bile duct size less than 7 mm.

*HPB Surgery and Transplant Unit

General Surgery Department, Castellón General Hospital, Castellon, Spain

Hepatogastroenterology Service and Transplant Unit, La Fe University Hospital, Valencia, Spain.

Reprints: Rafael López Andújar, MD, PhD, HPB Surgery and Transplant Unit, F Tower 5th Floor, La Fe University Hospital, 46026 Valencia, Spain. E-mail: rlopezandujar@telefonica.net.

Disclosure: The authors declare no sources of support for this work, including grants, equipment, and drugs. No funding was received for this work from any organization.

© 2013 by Lippincott Williams & Wilkins.