Liver transplantation: Do not abandon T-tube drainage-a multicentric retrospective study of the ARCHET research group.

Abstract

Biliary complications remain a real issue in liver transplantation (LT). Despite meta-analyses, the anastomosis technique, especially the use of biliary drain as T-Tube drain (TT) or transcystic drain, remains controversial. This study conducted by the ARCHET research group examine the incidence and types of biliary complications (BC) after LT according to the presence or absence of a biliary drain. 1485 patients with LT surgery between 2009 to 2015 in 4 LT centers were included, divided into 3 groups: no drain (ND n = 442), transcystic drain (TCD, n = 169) and TT(n = 874).The T-Tube group includes 3 techniques: transanastomotic, subanastomotic and tunneled retroperitoneal. Fistula and biliary stricture (AS) rates were studied. The risk factors of BC were investigated by multivariate analysis. The BC rate was lower in the TT group (17% TT, 25% TCD, 31% ND, p < 0.05), the complication rate Dindo-Clavien grade ≥ III is higher in the ND group (24% vs. 10% TT p < 0.05). Arterial complication has been found as a risk factor of BC with the multivariate analysis (p < 0.01, OR 1.86 [1.20-2.84]). In addition, the TT decreased by 5 the risk of AS (p < 0.05, OR 0.19 [0.12-0.28]). The fistula rate does not differ regardless of the reconstruction mode. In this study, biliary drain decreases the rate of BC. The findings confirmed the role of T-tube insertion in prevention of AS regardless of the way it is set up.