Key messages
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The effects of using a T-tube (a small drain placed in the duct that carries bile) on the risk of death from any cause, bile leaks, the need for a new transplant, and unwanted biliary events are unclear.
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It is unclear whether using a T-tube during bile duct surgery in adults having a liver transplant helps keep the bile duct open or increases complications caused by the drain itself.
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No study reported quality of life.
What is liver transplantation and biliary reconstruction?
Liver transplantation is an operation that replaces a severely diseased liver of a person with a healthy one from a donor. It is the definitive treatment for people with severe, end-stage liver disease or liver cancer. During this surgery, a critical step is joining the new liver's bile duct to the recipient's own bile duct (a technique called anastomosis). The bile duct is the tube that carries bile (a fluid that helps with digestion) from the liver to the intestine. Problems with this connection, such as leaks or narrowing, are important causes of illness and death after a transplant.
What is a T-tube?
A T-tube is a medical device (a small drain) placed in the bile duct during surgery. It is intended to help drain bile and allow doctors to check if the flow is blocked. There is no agreement among surgeons on whether using this tube helps prevent problems or whether the device itself causes new complications, such as infections or blockages.
What did we want to find out?
We wanted to find out if using a T-tube was better or worse than not using a drain in adults undergoing liver transplantation. We focused on:
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risk of death;
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serious bile duct complications (such as bile leaks or narrowing of the duct (stenosis));
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the need for a new transplant;
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quality of life.
What did we do?
We searched for studies that compared using a T-tube with not using one in adults who had a liver transplant. We compared and summarised the results of these studies and rated our confidence in the information, based on factors such as how the studies were performed and their size.
What did we find?
We found six studies involving 844 adults. These studies were conducted in Spain, France, the UK, and Germany, and were published between 1996 and 2013. Most studies lasted for at least 21 months (4 studies). Most participants were men (about 61%) with an average age of 54 years.
We have very little confidence in the results, so we cannot be certain of the effects of the T-tube.
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Death from any cause: we do not know whether using the T-tube makes a difference.
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Narrowing of the duct: using a T-tube may reduce the risk of bile duct narrowing, but the impact on the recipient is unclear.
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Bile leaks: we do not know whether using the T-tube affects the risk of bile leaking from the connection.
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Complications from the drain: using the T-tube itself may increase the risk of problems. However, we are very uncertain about the results.
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Retransplantation: we do not know whether the use of a T-tube affects the need for a new transplant.
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Unwanted biliary adverse events: we do not know whether using the T-tube makes a difference.
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No studies have provided information on quality of life.
What are the limitations of the evidence?
We have very little confidence in the results. The studies did not provide adequate information about how they were conducted, which is likely to introduce errors in their results. The studies were small, and the results varied widely across the studies.
No new studies have been published on this topic since 2013. All the included studies were conducted in European centres. Our results cannot be generalised to populations with different social and economic backgrounds. Since the last study included in this review was published, changes to transplantation practice have occurred. These changes affect donor selection for liver transplantation and organ preservation until they are transplanted into the person who needs it. Therefore, our findings may not apply to current transplantation practice.
How up to date is this evidence?
The evidence is up to date to 28 April 2026.
Baca abstrak penuh
Matlamat
To assess the benefits and harms of biliary anastomosis with the use of a T-tube compared with biliary anastomosis without the use of a T-tube in adults undergoing liver transplantation.
Kaedah Pencarian
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE ALL Ovid, Embase Ovid, Latin American and Caribbean Health Science Information Database (LILACS; VHL Regional Portal), Science Citation Index Expanded (Web of Science), and Conference Proceedings Citation Index - Science (Web of Science). We also searched online trial registries, reviewed reference lists of identified studies, and contacted, when necessary, the main authors of the included trials. All electronic searches were performed on 28 April 2026.
Kesimpulan Pengarang
The very low-certainty evidence precluded us from drawing robust conclusions regarding the clinical benefits or harms of using a T-tube versus no T-tube use in biliary anastomosis during adult liver transplantation.
We are very uncertain about the benefits and harms of T-tube use regarding all-cause mortality, anastomotic bile leak, retransplantation, and serious biliary adverse events. We are also very uncertain whether the T-tube may reduce the incidence of anastomotic biliary stenosis and increase complications attributable to the T-tube. We lack data on HRQoL.
We lack high-quality studies.
Pembiayaan
This study did not have any external sources of funding.
Pendaftaran
Protocol: doi.org/10.1002/14651858.CD013289
