THE USE OF THE T-TUBE AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

An end-to-end choledochocholedochostomy (CD) over a T tube or a Roux-e n-Y choledochojejunostomy (CDJ) have been the standard method of bilia ry reconstruction following orthotopic liver transplantation (OLTx). T he objective of this study was to assess whether or not use of the T t ube leads to increased biliary tract complications. Biliary tract comp lications were categorized as bile leak, stenosis, or obstruction that required therapeutic intervention. OLTx was performed in 161 patients over an 18-month period. Fifty-one patients were excluded from the st udy leaving a total of 110 patients for evaluation. Fifty-nine had the ir bile duct reconstructed over a T tube (CD T tube, group I) while th e remaining 51 patients underwent bile duct reconstruction without a T tube (CD, group II). No difference was noted between groups I and II in their survival rate, rate of conversion to Roux-en-Y CDJ, or biliar y complication rates. Our results indicate that CD (i.e., without a T tube) is both a safe and effective technique to reconstruct the biliar y tract following hepatic transplantation. Routine use of a T tube wit h a CD anastomosis is unnecessary in most liver transplant patients. I n addition, the omission of a T tube has reduced the number of radiolo gical procedures performed at our center.