title: T-tube or no T-tube in cadaveric orthotopic liver transplantation: the eternal dilemma: results of a prospective and randomized clinical trial.
abstract: 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.
  
  
  BACKGROUND
  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.
authors: HPB Surgery and Transplant Unit, Castellón General Hospital, Castellon, Spain. rlopezandujar@telefonica.net
authors: Rafael
authors: R
authors: López-Andújar
authors: Eva Montalvá
authors: EM
authors: Orón
authors: Andrés Frangi
authors: AF
authors: Carregnato
authors: Fabio Vergara
authors: FV
authors: Suárez
authors: Angel Moya
authors: AM
authors: Herraiz
authors: Fernando San Juan
authors: FS
authors: Rodríguez
authors: Juan José Vila
authors: JJ
authors: Carbó
authors: Eugenia Pareja
authors: EP
authors: Ibars
authors: Javier Escrig
authors: JE
authors: Sos
authors: Angel Rubín
authors: AR
authors: Suárez
authors: Martín Prieto
authors: MP
authors: Castillo
authors: José Mir
authors: JM
authors: Pallardó
authors: Manuel
authors: M
authors: De Juan Burgueño
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation*; D002102:Cadaver; D016009:Chi-Square Distribution; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome