T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation: An updated systematic review and meta-analysis

Table 1 Characteristics of all studies

Ref.	Study design	Year	T-tube	Number of patients	Gender1	Mean age (year)3	Mean CIT2,3 (min)	Jadad score
López-Andújar et al[25]	CS	2019	Y	240	139/101	58 ± 18	268 ± 109	1
			N	165	89/76	63 ± 14	265 ± 105
Ong et al[24]	CS	2018	Y	88	64/24	55	327	1
			N	37	27/10	51	316
Santosh Kumar et al[23]	RCT	2017	Y	31	NR	43.4 ± 11.1	NR	2
			N	33	NR	48.5 ± 11.6	NR
García Bernardo et al[22]	CS	2016	Y	23	21/2	55.3 ± 9.7	321 ± 108	1
			N	23	20/3	57.7 ± 6.6	343 ± 100
T. Anila et al[21]	RCT	2015	Y	13	NR	NR	73.3 ± 25.1	2
			N	13	NR	NR	74.9 ± 31.5
López-Andújar et al[20]	RCT	2013	Y	95	75/20	53.7 ± 7.68	316 ± 157	3
			N	92	66/26	53.2 ± 8.68	297 ± 143
Weiss et al[19]	RCT	2009	Y	99	69/30	53.3 ± 9.8	597 ± 159	3
			N	95	60/35	55.3 ± 6.7	559 ± 178
Lin et al[17]	CS	2007	Y	51	45/6	50.1 ± 10.0	NR	1
			N	53	47/6	52.0 ± 10.0	NR
Li et al[18]	CS	2007	Y	33	30/3	47.2 ± 9.4	479 + 98	1
			N	51	46/5	42.5 ± 13.5	457 + 89
Amador et al[16]	RCT	2005	Y	53	21/32	51.8 ± 9.4	362	3
			N	54	24/30	50.6 ± 10.6	390
Elola-Olaso et al[15]	CS	2005	Y	50	29/71	51.93 ± 9.8	NR	1
			N	50			NR
Scatton et al[14]	RCT	2001	Y	90	62/28	48.3 ± 9.9	604 ± 194	3
			N	90	58/32	49.2 ± 9.5	570 ± 153
Shimoda et al[13]	CS	2001	Y	76	33/43	51.8 ± 11.7	NR	1
			N	71	32/39	52.9 ± 12.3	NR
Rabkin et al[12]	CS	1998	Y	118	43/75	47.7	610	1
			N	44	7/37	48.0	522
Nuño et al[11]	RCT	1997	Y	50	NR	NR	NR	2
			N	48	NR	NR	NR
Vougas et al[10]	RCT	1996	Y	30	12/18	42.0	678	3
			N	30	13/17	45.0	696
Randall et al[9]	CS	1996	Y	59	NR	NR	NR	1
			N	51	NR	NR	NR

¹Female/Male.

²Mean ± standard deviation or mean.

³Cold ischemia time.

NR: No reference; Y: Yes; N: No; CS: Comparative study; RCT: Randomized control trial; CIT: Cold ischemia time.

Table 2 Measurements of outcomes provided in all studies

Outcome	Ref.	Year	With T-tube	Without T-tube
Total biliary complications	López-Andújar et al[25]	2019	31/240	20/165
	Ong et al[24]	2018	26/88	3/37
	García Bernardo et al[22]	2016	7/23	5/23
	López-Andújar et al[20]	2013	24/95	18/92
	Weiss et al[19]	2009	27/99	50/95
	Li et al[18]	2007	10/33	6/51
	Lin et al[17]	2007	5/51	9/53
	Amador et al[16]	2005	32/53	6/54
	Scatton et al[14]	2001	30/90	14/90
	Shimoda et al[13]	2001	25/76	11/71
	Rabkin et al[12]	1998	43/118	11/44
	Nuño et al[11]	1997	5/50	16/48
	Vougas et al[10]	1996	5/30	6/30
	Randall et al[9]	1996	13/59	7/51
Bile leak	López-Andújar et al[25]	2019	10/240	2/165
	Ong et al[24]	2018	2/88	1/37
	Santosh Kumar et al[23]	2017	11/31	4/33
	García Bernardo et al[22]	2016	4/23	2/23
	T. Anila et al[21]	2015	0/13	1/13
	López-Andújar et al[20]	2013	4/95	5/92
	Weiss et al[19]	2009	5/99	9/95
	Li et al[18]	2007	4/33	1/51
	Lin et al[17]	2007	1/51	1/53
	Amador et al[16]	2005	2/53	3/54
	Elola-Olaso et al[15]	2005	3/47	0/50
	Scatton et al[14]	2001	2/90	2/90
	Shimoda et al[13]	2001	4/76	5/71
	Rabkin et al[12]	1998	3/118	1/44
	Nuño et al[11]	1997	3/50	8/48
	Vougas et al[10]	1996	1/30	0/30
	Randall et al[9]	1996	5/59	0/51
Biliary stricture	López-Andújar et al[25]	2019	11/240	14/165
	Ong et al[24]	2018	11/88	2/37
	Santosh Kumar et al[23]	2017	7/31	2/33
	García Bernardo et al[22]	2016	2/23	3/23
	T. Anila et al[21]	2015	1/13	2/13
	López-Andújar et al[20]	2013	2/95	14/92
	Weiss et al[19]	2009	7/99	8/95
	Li et al[18]	2007	5/33	4/51
	Lin et al[17]	2007	5/51	8/53
	Amador et al[16]	2005	6/53	3/54
	Elola-Olaso et al[15]	2005	6/44	4/46
	Scatton et al[14]	2001	3/90	6/90
	Shimoda et al[13]	2001	5/76	6/71
	Rabkin et al[12]	1998	7/118	10/44
	Nuño et al[11]	1997	1/50	8/48
	Vougas et al[10]	1996	2/30	6/30
	Randall et al[9]	1996	8/59	7/51
Cholangitis	López-Andújar et al[25]	2019	6/240	0/165
	Ong et al[24]	2018	1/88	0/37
	López-Andújar et al[20]	2013	6/95	0/92
	Weiss et al[19]	2009	5/99	11/95
	Li et al[18]	2007	1/33	1/51
	Amador et al[16]	2005	8/53	0/54
	Elola-Olaso et al[15]	2005	5/45	1/49
	Scatton et al[14]	2001	4/90	3/90
	Vougas et al[10]	1996	2/30	0/30

Bold typed studies indicate randomized control trials.

Table 3 Meta-analysis of outcomes (all studies included)

Period	Outcome	Studies	Participants	Effect size OR, 95%CI (fixed/random)	Heterogeneity	Test for overall effect (fixed/random)	Publication bias	Study quality1	Favors
1995-2010	Overall biliary complications	10	1246	1.41 [0.66, 2.98]	I2 = 85.4% (bP = 0.001)	Z = 0.89/(P = 0.37)	Egger: Bias = 1.92; P = 0.60	3 × 4, 2 × 1, 1 × 5	None
	Bile leak	11	1346	1.04 [0.63, 1.70]	I2 = 16.7% (P = 0.29)	Z = 0.14/(P = 0.89)	Egger: Bias = 2.43; bP = 0.003	3 × 4, 2 × 1, 1 × 6	None
	Biliary stricture	11	1346	0.62 [0.42, 0.90]	I2 = 26.6% (P = 0.19)	Z = 2.51/(aP = 0.012)	Egger: Bias = -1.09; P = 0.56	3 × 4, 2 × 1, 1 × 6	With T-tube
	Cholangitis	6	725	2.00 [0.59, 6.84]	I2 = 53.6% (P = 0.06)	Z = 1.11/(P = 0.27)	Egger: Bias = 2.97; aP = 0.02	3 × 4, 1 × 2	None
2010-2020	Overall biliarycomplications	4	763	1.49 [1.00, 2.22]	I2 = 31.9% (P = 0.22)	Z = 1.97/(aP = 0.049)	Egger: Bias = 2.50; P = 0.22	3 × 1, 1 × 3	Without T-tube
	Bile leak	6	853	1.91 [1.01, 3.64]	I2 = 6.0% (P = 0.38)	Z = 1.98/(aP = 0.048)	Egger: Bias = -1.69; P = 0.30	3 × 1, 2 × 2, 1×3	Without T-tube
	Biliary stricture	6	853	0.76 [0.27, 2.12]	I2 = 62.3% (aP = 0.02)	Z = 0.53/(P = 0.60)	Egger: Bias = 0.84; P = 0.70	3 × 1, 2 × 2, 1 × 3	None
	Cholangitis	3	717	7.21 [1.37, 38.00]	I2 = 0.0% (P = 0.52)	Z = 2.33/(aP = 0.02)	Egger: Bias = -12.51; P = 0.12	3 × 1, 1 × 2	Without T-tube

¹Jadad scores × study number.

^aP < 0.05.

^bP < 0.01.

Odds ratio < 1 indicates the use of a T-tube. OR: Odds ratio; CI: Confidence interval.

Table 4 Sensitivity analysis of outcomes (only randomized control trials included)

Period	Outcome	Studies	participants	Effect size OR, 95%CI (fixed/random)	Heterogeneity	Test for overall effect (fixed/random)	Publication bias	Study quality1	Favors
1995-2010	Overall biliarycomplications	5	639	1.15 [0.28, 4.72]	I2 = 92.2% (bP = 0.001)	Z = 0.19/(P = 0.85)	Egger: Bias = 2.63; P = 0.71	3 × 4, 2 × 1	None
	Bile leak	5	639	0.56 [0.28, 1.13]	I2 = 0.0% (P = 0.72)	Z = 1.62/(P = 0.11)	Egger: Bias = 1.72; P = 0.08	3 × 4, 2 × 1	None
	Biliary stricture	5	639	0.45 [0.24, 0.85]	I2 = 0.0% (P = 0.46)	Z = 2.47/(aP = 0.014)	Egger: Bias= -2.78; P = 0.10	3 × 4, 2 × 1	With T-tube
	Cholangitis	4	541	1.83 [0.36, 9.41]	I2 = 65.6% (aP = 0.03)	Z = 0.72/(P = 0.47)	Egger: Bias = 3.39; P = 0.054	3 × 4	None
2010-2020	Bile leak	3	277	1.38 [0.34, 5.65]	I2 = 50.9% (P = 0.13)	Z = 0.45/(P = 0.66)	Egger: Bias = -1.94; P = 0.62	3 × 2, 2 × 1	None
	Biliary stricture	3	277	0.63 [0.06, 6.99]	I2 = 80.3% (aP = 0.01)	Z = 0.38/(P = 0.71)	Egger: Bias = 1.08; P = 0.92	3 × 2, 2 × 1	None

¹Jadad scores × study number.

^aP < 0.05.

^bP < 0.01.

Odds ratio < 1 indicates the use of a T-tube. OR: Odds ratio; CI: Confidence interval.