Background: In whole liver transplantation, functional regeneration is essential for the graft to recover from the ischemia-reperfusion injury, and for the recipients to regain a normal liver function and recover from the pre-LT cirrhosis-related complications. The failure of this process is clinically diagnosed as early allograft dysfunction (EAD). Bile acids have been identified as a crucial trigger for liver regeneration, and their deprivation due to the use of a T tube at LT may increase the risk of EAD.
Methods: A retrospective study on a cohort of 257 LT recipients during the period 2010-2018. Exclusion criteria were split grafts, biliary or vascular complications, graft loss or patient's death, within postoperative day 7. EAD was defined according to the criteria of Olthoff et al, and graded according to the Model for Early Allograft Function (MEAF) score.
Results: EAD developed in 24.5% of recipients and the median MEAF score was 3.8 [interquartile range 2.8-5.6]. A T-tube was placed in 47.5% of recipients. Significant risk factors for EAD in multivariate analysis were the total ischemia time (TIT) ( Odds ratio [OR]  1.058, p 0.001) and T-tube use (OR 2.405, p 0.027), while significant predictors of MEAF in multivariate analysis were the MELD score (regression coefficient [RC] 0.059, p 0.002), pre-donation gGT (RC 0.04, p 0.008), TIT (RC 0.04, p 0.002) and T-tube use (RC 0.71, p 0.015). Both MEAF (OR 1.334, p 0.009) and EAD (OR 2.644, p 0.032) predicted 90-days post-LT mortality.
Conclusions: In LT, T-tube use is an independent risk factor for EAD and predictor of MEAF. Its uses should be limited to cases with technically complex biliary reconstruction and the drained bile might be re-administered to prevent the interruption of the enterohepatic cycle.