title: Predictors of Biliary Leakage After T-Tube Removal in Living Donor Liver Transplantation Recipients.
abstract: BACKGROUND
  Biliary leakage after T-tube removal is a frequent cause of morbidity in liver transplant recipients. The aim of this study was to determine the factors that predict the development of biliary leakage after T-tube removal in living donor liver transplantation (LDLT) recipients.
  
  
  METHODS
  Of the 144 patients who underwent LDLT with right-lobe liver grafts during the period January 2007 to May 2013 at a single medical center, 40 received biliary anastomosis with T-tube placement. Subjects were grouped into either a biliary leakage or non-biliary leakage group on the basis of the presence or absence of abdominal symptoms associated with signs of peritoneal irritation after T-tube removal. Recipient, graft, operative, and postoperative factors were included in a forward, stepwise multiple logistic regression model to identify the most important risk factors for biliary leakage after T-tube removal.
  
  
  RESULTS
  Biliary leakage developed in 9 (22.5%) patients after T-tube removal. Risk factors associated with biliary leakage included the number of abdominal surgeries performed [odds ratio (OR) = 12.6, 95% confidence interval (CI): 2.1-20.4] and duration of T-tube placement (OR = 6.9, 95% CI: 1.2-10.7).
  
  
  CONCLUSIONS
  Biliary leakage after T-tube removal is associated with significant morbidity in LDLT recipients. We suggest that T-tube placement be used sparingly in LDLT biliary reconstruction. When used, a T-tube should not be removed earlier than 8 months after placement, especially in recipients who have received primary abdominal surgery.
authors.affiliation: Organ Transplant Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: S-H
authors.initials: SH
authors.lastname: Wang
authors.affiliation: Transplant Medicine and Surgery Research Centre, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Lin
authors.affiliation: Department of Health Care Administration, Asia University, Taichung, Taiwan.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Senior Citizen Welfare and Business, Hung Kuang University, Taichung, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Organ Transplant Center, Changhua Christian Hospital, Changhua, Taiwan.
authors.forename: C-E
authors.initials: CE
authors.lastname: Hsieh
authors.affiliation: Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan, and School of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: 31560@cch.org.tw.
authors.forename: Y-L
authors.initials: YL
authors.lastname: Chen
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology*; D001659:Biliary Tract / Q000378:metabolism; D001660:Biliary Tract Diseases / Q000209:etiology*; D020878:Device Removal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D066027:Transplant Recipients