Design: Cochrane systematic review and meta-analysis of randomised trials
Population: 6 RCTs, 844 adults undergoing liver transplantation
Primary outcome: Mortality, biliary leak, stricture, tube complications
Effect: Stricture RR 0.33 (0.15–0.71); tube complications RR 17.81 (5.51–57.58); very low certainty

An updated Cochrane review (22 September) found six randomised trials, 844 adults, comparing duct-to-duct biliary anastomosis with or without a T-tube during liver transplantation. All were published between 1996 and 2013.

T-tubes may reduce anastomotic stricture (RR 0.33, 95% CI 0.15 to 0.71) but were associated with many more tube-related complications (RR 17.8). There was no clear difference in mortality, bile leak, retransplantation or serious biliary events, and certainty was very low for every outcome. No trial reported quality of life.

The evidence neither supports nor rules out T-tube use. Practice will continue to rest on centre experience; the trials are old and predate much of modern transplant practice.

Evidence on T-tube use in liver transplantation is very low certainty.
A possible reduction in strictures is offset by frequent tube-related complications.
No trial has reported quality of life.
All included trials are more than a decade old.

Why it matters

It confirms a long-standing surgical choice remains a matter of centre practice, not evidence.

The statistics, in plain English

A risk ratio of 17.8 for tube-related complications is large but reflects that such complications cannot occur without a tube. Very low certainty means the true effects could be substantially different.