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Predicting early discharge from hospital after liver transplantation (ERDALT) at a single center: a new model
Federico Piñero
,
Corresponding author
fpinerof@cas.austral.edu.ar

Correspondence and reprint request:
, Martín Fauda*, Rodolfo Quiros**, Manuel Mendizabal*, Ariel González-Campaña*, Demian Czerwonko***, Mariano Barreiro*, Silvina Montal*, Ezequiel Silberman*, Matías Coronel*, Fernando Cacheiro****, Pía Raffa*, Oscar Andriani*, Marcelo Silva*, Luis G. Podestá*
* Hepatology and Liver Transplant Unit. Hospital Universitario Austral, Buenos Aires, Argentina
** Internal Medicine, Infectious Diseases and Statistics. Hospital Universitario Austral, Buenos Aires, Argentina
*** Intensive Care Unit. Hospital Universitario Austral, Buenos Aires, Argentina
**** Department of Anesthesiology. Hospital Universitario Austral, Buenos Aires, Argentina
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan Meier patient &#40;<span class="elsevierStyleBold">A</span>&#41; and graft &#40;<span class="elsevierStyleBold">B</span>&#41; 3-year survival comparative analysis between patients with and without early discharge from hospital after liver transplantation&#46; Kaplan Meier curves revealed significant differences on 3-year patient and graft survival rates between patients with and without ERDALT &#40;97&#46;1 <span class="elsevierStyleItalic">vs&#46;</span> 79&#46;2&#37;&#44; respectively&#59; P &#61; 0&#46;021&#44; and 91&#46;2&#37; <span class="elsevierStyleItalic">vs&#46;</span> 74&#46;5&#37;&#44; P &#61; 0&#46;05&#44; log rank test&#44; respectively&#41;&#46; ERDALT&#58; early discharge from hospital after liver transplantation&#46; LT&#58; liver transplantation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Liver transplantation &#40;LT&#41; has become an acceptable medical therapy and the gold standard for treating patients with end-stage liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Short and long-term survival&#44; as well as quality of life after LT have improved over the last 20 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; LT is still one of the most complex and costly medical therapies&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> During the last years&#44; special attention has been focused on the unbalanced and escalating costs of health care concomitantly with limited financial resources in South America&#46; However&#44; there is scarce information related to LT costs in these countries&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Additionally&#44; costs analysis from LT programs in developed countries may not provide comparable or applicable models for those in emerging economies&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">As shown by several authors&#44; transplant outcomes depend on pre and post-transplantation factors&#44; which include both recipient and donor fitness&#44; surgeon&#8217;s skills and transplant unit team&#8217;s experience&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Recently published series from developed countries have postulated predictors of prolonged length of hospital stay &#40;LOS&#41; and discharge destination following LT&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Early discharge after LT can be feasible&#59; however&#44; to our knowledge&#44; no studies on economic impact of this strategy have been published in South America&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Different common problems are seen in most South American countries&#44; such as overpopulation&#44; unorganized urbanization&#44; inflation&#44; poverty and lack of elementary health and social services&#46; Ultimately&#44; this economic burden may impact on the health care of the population&#46; Liver transplantation has been performed since 1968 in South America&#59;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> still&#44; there are some countries without LT programs in this region&#46; In most of these nations&#44; lack of financial support&#44; as well as lack of educational policies on organ donation exist&#44; ultimately barring access to transplantation&#46; It is in this economic scenario that strategies aimed at reducing medical costs are needed&#46;</p><p id="p0020" class="elsevierStylePara elsevierViewall">We believe identifying predictors of Early Discharge after LT &#40;ERDALT&#41; is feasible&#46; In an attempt identify immediate pre and post-LT predictors of ERDALT&#59; we have recently reviewed our clinical care pathways and discharge planning processes following LT&#46; The aim of this study was to propose a clinical predictive score of ERDALT that would help to identify those patients who might be discharge earlier&#44; prepare them better for the post-transplant period and reduce transplant costs&#46;</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Material and Methods</span><p id="p0025" class="elsevierStylePara elsevierViewall">Prospectively collected data was retrospectively reviewed including all consecutive adult &#40;&#8805; 18 years&#41; liver transplant recipients between October 2001 and December 2013 in order to identify predictive factors for ERDALT&#46; This study was conducted at the Austral University Hospital&#44; from Argentina&#46; Pediatric patients were excluded from the analysis&#46; Information was obtained from medical records and from an electronic database&#46; Patients who died during the immediate post transplant period and were not discharged from hospital were also included in the analysis&#46;</p><p id="p0030" class="elsevierStylePara elsevierViewall">Pre-transplant variables included in the analysis were&#58; recipient&#8217;s age&#44; gender&#44; etiology of liver disease&#44; history of previous abdominal surgery and presence of clinically severe ascites&#46; Additionally&#44; patient hospitalization status in Intensive Care Unit &#40;ICU&#41; and renal replacement therapy &#40;RRT&#41; immediately prior to transplant were recorded&#46; Laboratory values registered at the time of transplantation were serum creatinine&#44; prothrombine time&#44; International Normalized Ratio &#40;INR&#41;&#44; total bilirubin&#44; serum sodium and serum albumin&#46; Immediate pre-transplant Model for End Stage Liver Disease &#40;MELD&#41; score was calculated and patients receiving a MELD exception allocation policy were registered&#44; namely&#58; Hepatocellular carcinoma &#40;HCC&#41; within Milan criteria&#44; and non-HCC reasons such as hepatopulmonary syndrome&#44; familial amiloidotic polyneuropathy&#44; biliary cholangitis&#44; vascular disorders&#44; post-transplant acute artery thrombosis and refractory ascites&#46;</p><p id="p0035" class="elsevierStylePara elsevierViewall">Donor characteristics&#44; age and body mass index &#40;BMI&#41;&#44; donor and fluid transport microbial cultures&#44; as well as cold ischemia time &#40;CIT&#41; were registered&#46; Duration of LT surgery &#40;hours&#41;&#59; surgical technique&#44; use of Piggy Back technique&#44; T tube placement&#44; type of biliary anastomosis and total blood product consumption &#40;BPC&#41; during organ implant were also included&#46; Total BPC estimation was based on the sum of red blood cells&#44; platelets&#44; cryoprecipitates and plasma units consumed during surgery&#46; Finally&#44; need for RRT and in-hospital infection events after LT were analyzed&#46; The latter was defined as any infectious event requiring antimicrobial treatment during transplant hospitalization&#46;</p><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Length of hospital stay after liver transplantation</span><p id="p0040" class="elsevierStylePara elsevierViewall">We define LOS as the number of consecutive days from the date of transplantation until hospital discharge&#44; either home or to a special care facility&#46; If a patient was re-transplanted during the first LT hospitalization&#44; LOS was considered from the date of the first LT until discharge&#46; Applying a preselected cutoff value&#44; those patients who were discharged from hospital before the 8th day post transplant were considered ERDALT&#46; This cut-off was previously selected considering recently published data with a mean LOS of 14&#46;9 &#177; 13&#46;9 days&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> 16&#46;3 &#177; 18&#46;2 days&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and 13&#46;7 &#177; 17&#46;5 days&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Additionally&#44; length of ICU stay after transplantation until transfer to general ward and days of assisted mechanical ventilation &#40;AMV&#41; after LT were recorded in all patients&#46; Early extubation or early weaning form AMV was considered in cases where AMV lasted &#60; 12 h&#46;</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0030">Economic analysis</span><p id="p0045" class="elsevierStylePara elsevierViewall">Liver transplant costs were calculated for each transplant event&#46; Only costs directly attributable to the procedure&#44; during hospitalization and its immediate complications were applied&#46; Cost data were obtained from the costs of BPC during surgery&#44; use of cell saver during surgery&#44; induction and maintenance immunosuppression&#44; antimicrobial prophylaxis&#44; rejection episodes&#44; ICU stay and LOS&#46; In addition&#44; costs related to in-hospital infection events were also calculated&#46; Professional fees of hepatologists&#44; transplant surgeons and anesthesiologists were included&#44; although the corresponding fees of the rest of the physicians with fixed salary were not included&#46; Liver transplantation costs were retrospectively calculated applying actual financial values prevailing in Argentina during 2014 and were expressed in US dollars&#46; Average hospital stay costs per-day included expenses related to hospital bed&#44; medications&#44; blood tests and imaging studies&#46; Costs of readmissions were not considered&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Endpoints&#47;Definitions</span><p id="p0050" class="elsevierStylePara elsevierViewall">Primary outcomes analyzed were early discharge from hospital&#44; and patient and graft survival&#59; while secondary outcomes were rate of biopsy-proven acute cellular rejection events &#40;ACR&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> rate of shortterm re-hospitalization &#40;during the first 30 days after discharge from hospital&#41; and overall LT costs&#46; The Institutional Review Board approved the study protocol and written informed consent was obtained from all patients &#40;or a family member&#41;&#46; This study was conducted in conformance with the 2008 Helsinki Declaration&#46;</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Statistical analysis</span><p id="p0055" class="elsevierStylePara elsevierViewall">Categorical data were compared applying Fisher&#8217;s exact test &#40;2-tailed&#41; or &#967;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>-Square test with Yates&#8217; correction&#46; Continuous variables were compared with Student&#8217;s T test &#40;mean &#177; standard deviation&#41; or Mann-Whitney U test &#40;median and interquartile ranges&#44; IQR&#41; according to their distribution&#46; Continuous variables were transformed into qualitative or ordinal variables based on either cut-offs values based on receiver-operating characteristic curve &#40;ROC&#41; analysis or clinical relevance or the median value of the parameter&#46; Univariate and multivariate analysis&#44; using logistic regression were performed in order to identify significant variables related to ERDALT&#46; Those variables with a P value &#60; 0&#46;1 in the univariate analysis were included in the multivariate regression model&#44; generated by stepwise backward elimination &#40;Wald test&#41;&#44; P &#60;0&#46;05&#46; Odds Ratios &#40;OR&#41; and 95&#37; Confidence Intervals &#40;CI&#41; derived for each factor in the multivariate analysis were subsequently used as weights &#40;rounded OR&#8217;s values divided by the lowest OR observed&#41; to construct a simple clinical prediction rule&#46; Final scores corresponded to sum of points for each individual patient&#46; Calibration and validation of the model was performed by Hosmer-Lemeshow test and bootstrapping technique &#40;1000 samples&#41;&#44; respectively&#46; Model goodness of fit and discrimination power was assessed by ROC analysis and concordance statistic calculated&#46; Finally&#44; Kaplan Meier survival curves were performed and compared using log-rank test&#46; Collected data was analyzed with R software &#40;version 3&#46;0&#46;1 for Mac&#41;&#46;</p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Results</span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Demographic characteristics and clinical data</span><p id="p0060" class="elsevierStylePara elsevierViewall">A total of 289 patients were included in the analysis&#46; Mean recipients&#8217; age was 52 &#177; 13 years&#44; 168 were male &#40;58&#46;1&#37;&#41;&#44; 58 patients had pre transplant diabetes mellitus &#40;20&#46;6&#37;&#41;&#46; Principal etiologies of liver disease were hepatitis C virus infection 21&#46;8&#37; &#40;n &#61; 63&#41;&#44; alcoholic liver disease 13&#46;8&#37; &#40;n &#61; 39&#41; and non-alcoholic fatty liver disease 13&#46;5&#37; &#40;n &#61; 38&#41;&#46; Overall&#44; 29 patients had acute liver failure &#40;10&#46;0&#37;&#41;&#44; 17 patients re-transplantation &#40;5&#46;6&#37;&#41;&#44; 9 patients with simultaneous liver-kidney transplantation &#40;3&#46;1&#37;&#41;&#44; 22 patients received a living donor LT &#40;7&#46;5&#37;&#41; and 41 patients had HCC &#40;14&#46;2&#37;&#41;&#46; MELD supplementary points were allocated in 53 patients &#40;18&#46;7&#37;&#41;&#44; of whom 26 &#40;49&#46;1&#37;&#41; and 27 patients &#40;50&#46;9&#37;&#41; were because of HCC within Milan criteria and other non-HCC reasons&#44; respectively&#46; Fifty-one patients were located at ICU immediately before transplant &#40;18&#46;2&#37;&#41;&#44; and 6 patients were under RRT&#46; Mean transplant surgery time was 6&#46;6 &#177; 2&#46;2 hs&#44; with a median BPC of 16 units &#40;IQR 13 units&#41; and cell saver was used in 61 patients &#40;22&#46;9&#37;&#41;&#46; Early extubation from AVM was performed in 157 patients &#40;54&#46;4&#37;&#41;&#46; Positive microbial cultures on donor or graft transport fluids were observed in 21 &#40;7&#46;3&#37;&#41; and 24 patients &#40;8&#46;3&#37;&#41;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0065" class="elsevierStylePara elsevierViewall">Overall median LOS was 14&#46;5 days &#40;IQR 13 days&#41;&#44; with a median stay in ICU and duration of AMV of 5 and 0 days&#44; respectively&#46; In-hospital mortality rate was 9&#46;9&#37; &#40;n &#61; 30&#41;&#44; whereas in-hospital infections and short-term re-hospitalization rates were 38&#46;8&#37; &#40;n &#61; 112&#41; and 23&#46;3&#37; &#40;n &#61; 60&#41;&#44; respectively&#46; One hundred and twelve patients &#40;38&#46;9&#37;&#41; had at least 1 ACR event&#44; 29&#37; &#40;n &#61; 32&#41; of these events occurred during LT hospitalization and 71&#37; &#40;n &#61; 80&#41; after discharge from hospital&#46; The median LT cost among the entire cohort was &#36;28&#44;206 &#40;IQR 8&#44;536&#41;&#46; For a median follow-up time of 35 months&#44; overall patient and graft survival rates at 1 and 5 years after LT were 86&#46;8 and 76&#46;8&#37;&#44; and 76&#46;7 and 75&#46;4&#37;&#44; respectively&#46;</p></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Patients with early discharge from hospital after liver transplantation</span><p id="p0070" class="elsevierStylePara elsevierViewall">Thirty-four patients &#40;11&#46;8&#37;&#41; were discharged within the first 8 days post LT&#46; Patients who were discharged early had lower pre transplant MELD score &#40;15 &#177; 11 <span class="elsevierStyleItalic">vs&#46;</span> 19 &#177; 10&#44; P &#61; 0&#46;021&#41;&#44; and 47&#46;1&#37; of these were granted with MELD exception points &#40;n &#61; 16&#47;34&#59; P &#60; 0&#46;0001&#41;&#46; No significant differences related to proportion of patients with HCC and MELD exception points between groups were observed&#46; Significant differences were observed between patients with or without ERALDT among the following baseline parameters&#58; presence of severe pre-LT ascites &#40;23&#46;5 <span class="elsevierStyleItalic">vs&#46;</span> 43&#46;3&#37;&#59; P &#61; 0&#46;02&#41; and pre-LT serum creatinine &#40;0&#46;81 &#177; 0&#46;35 mg&#47;dL <span class="elsevierStyleItalic">vs&#46;</span> 1&#46;13 &#177; 0&#46;89 mg&#47;dL&#59; P &#61; 0&#46;04&#41;&#46; No statistically significant differences were observed regarding quality of donors&#44; namely&#58; age &#40;41 &#177; 17 <span class="elsevierStyleItalic">vs&#58;</span> 40 &#177; 16 years&#59; P &#61; 0&#46;67&#41;&#44; donor BMI &#40;27&#46;7 &#177; 5&#46;5 <span class="elsevierStyleItalic">vs&#46;</span> 25&#46;8 &#177; 3&#46;4 kg&#47;m<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; P &#61; 0&#46;08&#41;&#44; positive microbial cultures on donor or graft transport fluids &#40;20&#46;6 <span class="elsevierStyleItalic">vs&#46;</span> 13&#46;7&#37;&#59; P &#61; 0&#46;20&#41;&#44; or CIT duration &#40;6&#46;6 &#177; 1&#46;8 <span class="elsevierStyleItalic">vs&#46;</span> 7&#46;7 &#177; 2&#46;1 h&#44; P &#61; 0&#46;49&#41;&#46;</p><p id="p0075" class="elsevierStylePara elsevierViewall">LT surgery time was shorter for ERDALT patients &#40;4&#46;8 &#177; 2&#46;2 <span class="elsevierStyleItalic">vs&#46;</span> 6&#46;8 &#177; 2&#46;1 h&#59; P &#60; 0&#46;0001&#41;&#44; no T tube placement was required &#40;0 <span class="elsevierStyleItalic">vs&#46;</span> 30&#46;6&#37;&#59; P &#61; 0&#46;004&#41; and less median BPC during LT surgery was observed &#40;5&#46;0 <span class="elsevierStyleItalic">vs&#46;</span> 18&#46;0 units&#59; P &#60; 0&#46;0001&#41;&#46; Median LOS of patients with and without ERDALT was significantly different &#40;7&#46;0 <span class="elsevierStyleItalic">vs&#46;</span> 15&#46;5 days&#59; P &#60; 0&#46;0001&#41;&#44; as well as ICU stay &#40;4&#46;0 vs&#46; 5&#46;0 days&#59; P &#61; 0&#46;014&#41;&#46; ERDALT patients were more frequently early extubated from AMV &#40;91&#46;2 <span class="elsevierStyleItalic">vs&#46;</span> 49&#46;6&#37;&#59; P &#60; 0&#46;0001&#41; and presented less in-hospital infections events &#40;0 <span class="elsevierStyleItalic">vs&#46;</span> 43&#46;9&#37;&#59; P &#61; 0&#46;0001&#41;&#46;</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Survival analysis&#44; liver transplant costs and re-hospitalization rates</span><p id="p0080" class="elsevierStylePara elsevierViewall">Kaplan Meier analysis revealed significant differences with respect to patient and graft survival at 1 and 5 years between patients with and without ERDALT&#46; Kaplan Meier curve revealed significant difference on 3-year patient survival rate and a trend for improved graft survival between patients with and without ERDALT &#40;97&#46;1 <span class="elsevierStyleItalic">vs&#46;</span> 79&#46;2&#37;&#44; respectively&#59; P &#61; 0&#46;02&#44; and 91&#46;2&#37; <span class="elsevierStyleItalic">vs&#46;</span> 74&#46;5&#37;&#44; P &#61; 0&#46;05&#44; log rank test&#44; respectively&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><p id="p0085" class="elsevierStylePara elsevierViewall">There were no significant differences between both groups regarding early re-hospitalization rate &#40;ERDALT 20&#46;6&#37;&#44; n &#61; 7&#47;34 <span class="elsevierStyleItalic">vs&#46;</span> no ERDALT 23&#46;8&#37;&#44; n &#61; 53&#47;223&#59; P &#61; 0&#46;43&#41;&#46; Patients with ERDALT had lower rate of ACR during the first 3 months after LT than patients discharged from hospital later &#40;18&#46;2&#37;&#44; n &#61; 6&#47;34 <span class="elsevierStyleItalic">vs&#46;</span> 42&#46;0&#37;&#44; n &#61; 94&#47; 224&#59; P &#61; 0&#46;006&#41;&#44; and similar rate of ACR after hospital discharge &#40;14&#46;7&#37;&#44; n &#61; 5&#47;34 vs&#46; 10&#46;7&#37;&#44; n &#61; 24&#47;224&#59; P &#61; 0&#46;32&#41;&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">Analysis of expenditure comparison between patients with or without ERDALT revealed that the median overall LT costs were lower for early discharge patients &#40;&#36;23&#44;078&#44; IQR 6&#44;866 <span class="elsevierStyleItalic">vs&#46;</span> &#36;28&#44;986&#44; IQR 118&#44;036&#59; P &#60; 0&#46;0001&#44; respectively&#41;&#46; This difference between subgroups were due to a significant difference in costs of hospital stay &#40;&#36;1&#44;113&#44; IQR 1&#44;013 <span class="elsevierStyleItalic">vs&#46;</span> &#36;823&#44; IQR 19&#44;664&#59; P &#60; 0&#46;0001&#41;&#44; cost of duration of the transplant surgery &#40;&#36;929&#44; IQR 709 <span class="elsevierStyleItalic">vs&#46;</span> &#36;1&#44;229&#44; IQR 2&#44;930&#59; P &#60; 0&#46;0001&#41;&#44; BPC &#40;&#36;713&#44; IQR 1&#44;718 <span class="elsevierStyleItalic">vs&#46;</span> &#36;1&#44;396&#44; IQR 12&#44;175&#59; P &#60; 0&#46;0001&#41;&#44; ICU stay &#40;&#36;2&#44;261&#44; IQR 1&#44;130 <span class="elsevierStyleItalic">vs&#46;</span> &#36;3&#44;391&#44; IQR 105&#44;138&#59; P &#60; 0&#46;0001&#41; and immunosuppression during hospitalization &#40;&#36;459&#44; IQR 262 <span class="elsevierStyleItalic">vs&#46;</span> &#36;1&#44;050&#44; IQR 12&#44;216&#59; P &#60; 0&#46;0001&#41;&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Predictive variables for early discharge from hospital after liver transplantation</span><p id="p0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t0010">Table 2</a> shows immediate pre and post-LT associated variables with ERDALT in the univariate analysis&#46; Pre-LT variables associated with ERDALT were as follows&#58; MELD score &#60; 15 &#40;P &#61; 0&#46;03&#41;&#44; supplementary MELD points &#40;P &#60; 0&#46;0001&#41;&#44; severe ascites &#40;P &#61; 0&#46;03&#41; and ICU stay immediately before transplant &#40;P &#61; 0&#46;04&#41;&#46; Among post transplant variables&#44; LT surgery duration &#60; 4 h &#40;P &#60; 0&#46;0001&#41;&#44; requirement of &#60; 5 units of BPC &#40;P &#60; 0&#46;0001&#41; and early weaning from AMV &#40;P &#60; 0&#46;0001&#41; were related with ERDALT&#46; Variables independently associated with ERDALT after multivariate stepwise regression analysis were MELD exception points OR 1&#46;9 &#40;1&#46;09-4&#46;87&#44; P &#61; 0&#46;04&#41;&#44; surgery time &#60; 4 h OR 3&#46;8 &#40;1&#46;34-10&#46;64&#44; P &#61; 0&#46;013&#41;&#44; &#60; 5 units of BPC OR 3&#46;5 &#40;1&#46;47-8&#46;45&#44; P &#61; 0&#46;001&#41; and early weaning from AMV OR 6&#46;3 &#40;1&#46;75-22&#46;33&#44; P &#61; 0&#46;006&#41;&#46; Model calibration with Hosmer-Lemeshow test showed no significant differences between observed and expected events &#40;P &#61; 0&#46;58&#41;&#46; Bootstrap validation showed overfitting was negligible and therefore no adjustment of logistic regression model estimates was required &#40;<a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0100" class="elsevierStylePara elsevierViewall">Using these variables&#44; a predictive score for ERDALT was constructed&#46; Each of the predictors was assigned with points depending on its OR from logistic regression multivariate analysis divided by 1&#46;9&#44; which was the lowest OR observed&#46; Points in the predictive scoring system for ERDALT were allocated as follows&#58; MELD exception points &#40;absence &#61; 0 points&#44; presence &#61; 1 point&#41;&#44; surgery time &#60; 4 h &#40;absence &#61; 0 points&#44; presence &#61; 2 points&#41;&#44; &#60; 5 units of BPC &#40;absence &#61; 0 points&#44; presence &#61; 2 points&#41;&#44; and early weaning from AMV &#40;absence &#61; 0 points&#44; presence &#61; 3 points&#41;&#40;<a class="elsevierStyleCrossRef" href="#t0020">Table 4</a>&#41;&#46; Final scores ranged from 0 to 8 points and ROC curve revealed good discriminatory power for the model with a c-statistic of 0&#46;83 &#40;95&#37; CI 0&#46;77-0&#46;90&#59; P &#60; 0&#46;0001&#41;&#44; and best performance for a cut-off &#8805; 3 points &#40;67&#37; sensitivity&#44; 82&#37; specificity&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0010">Figure 2</a>&#41;&#46; Positive and negative predictive values were 0&#46;20 and 0&#46;99&#44; respectively&#46; Probability of ERDALT increased progressively as scores went from 0-1 to 2-3&#44; 4-5 to 6-8 points in the following percentages&#58; 0&#46;9&#37; &#40;n &#61; 1&#47;116&#41;&#44; 9&#46;7&#37; &#40;n &#61; 10&#47; 103&#41;&#44; 19&#46;0&#37; &#40;n &#61; 8&#47;42&#41;&#44; and 53&#46;4&#37; &#40;n &#61; 15&#47;28&#41;&#44; respectively &#40;Goodman &#38; Kruskall Gamma P &#61; 0&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0015">Figure 3</a>&#41;&#46; A clinical nomogram and possible clinical scenarios and application are shown in <a class="elsevierStyleCrossRef" href="#f0020">figure 4</a>&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="f0020"></elsevierMultimedia></span></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Discussion</span><p id="p0105" class="elsevierStylePara elsevierViewall">Our results provide relevant information in the field of health care costs of LT&#46; We have evaluated the feasibility of early discharge from hospital after LT and constructed a predictive model&#46; Our data shows that the following immediate pre and post-LT variables can identify patients suitable for ERDALT&#58; exception MELD points&#44; &#60; 5 units of BPC&#44; surgery time &#8804; 4 h and early weaning from AMV&#46; We believe that using these factors might be an additional tool to identify patients suitable for a short hospitalization and help reducing LT hospitalization costs&#46; This cost opportunity should also be viewed in light of the fact that early discharge from hospital may allow more procedures&#44; operations for other patients as well as less occupation of hospital beds&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">Recently published data from the United Network for Organ Sharing &#40;UNOS&#41; has shown that mean LOS is 14&#46;9 &#177; 13&#46;9 days&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Other series have reported LOS of 16&#46;3 &#177; 18&#46;2 days&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> and 13&#46;7 &#177; 17&#46;5 days&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">&#8211;</span><a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Overall median LOS in our series was 14&#46;5 days&#44; 12&#37; of the patients were discharged from hospital during the first week after surgery with a short-term re-hospitalization rate of 23&#37;&#46; Predictors of LOS after LT have already been described&#44; such as recipient and donor age&#44; two or more previous liver transplants&#44; ICU status prior to LT&#44; recipients&#8217; body mass index &#40;BMI&#41;&#44; RRT before transplantation<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> and early extubation from AMV after surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> We chose a cut-off for ERDALT of 8 days based on these aforementioned data and considering that our median LOS was 14&#46;5 days&#46; We considered that an 8-day cut off was clinically relevant&#44; and statistically comparable between groups&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">We focused our analysis on immediate pre and post-LT variables related with LOS after LT&#46; Neither recipient or donor age&#44; nor re-transplantation or kidney-liver transplantation showed any significant relationship&#46; Although pre-transplant MELD score did show a link&#44; the only variable included in the MELD score that remained relevant in relation to ERDALT after multivariate analysis was serum creatinine&#46; Controversy however persists in previously reported series regarding MELD score and LOS&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> However&#44; those patients granted with supplementary MELD points&#44; particularly those with HCC&#44; had the highest probability of early discharge from hospital&#46; Immediate post-transplant variables&#44; such as &#60; 5 units of BPC&#44; early weaning from AMV and LT surgery duration &#60; 4 h were considered factors affecting LOS and were included in the final model&#46; It seems that the influence of pre-transplant variables on the ERDALT predictive model&#44; including those related with portal hypertension and its complications&#44; appear to be lower than those events occurring during the transplant procedure or immediate post-LT period&#46; It may be that these data might be surrogate markers of a short and uncomplicated transplant surgery&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">Previously reported data indicates liberation from mechanical ventilation shortly after LT is feasible&#46; Some authors have even recommended immediate extubation after surgery&#44; thus circumventing ICU stay entirely&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This strategy has not been applied at our center&#46; All patients are transferred to the ICU following transplantation&#46; In the article of reference&#44; LT operative time and intraoperative transfusion requirements were described as predictors for need of ICU admission&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> These authors proposed a scoring model for fast tracking and avoiding costly ICU stay after LT&#46; Nine variables were identified&#44; including BPC&#44; operative time&#44; MELD score&#44; body mass index and age at time of transplant&#46; Our model included only 4 variables&#44; including 1 pre LT and 3 immediate post LT factors&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">Conflicting data has been reported regarding the impact of donor variables on LOS and LT costs&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> No significant differences in CIT or rate of positive donor microbial cultures between patients with and without ERDALT were observed&#46; It could be argued that patients with ERDALT had shorter LOS because this group also presented lower ACR events and in-hospital infections events&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Again&#44; the variables included in the multivariate model might be surrogate markers of lower ACR and in-hospital infection events&#46; In hospital infection was considered present not only in patient manifesting symptoms of infection &#40;bacterial&#44; viral or fungi&#41;&#44; but also in cases with positive microbial cultures in samples from on donor tissue or graft transport fluid &#40;13&#46;7&#37;&#41;&#46; Although inhospital infection rates seem high in this series&#44; exclusion of the latter group would cause the total to drop to 29&#46;3&#37;&#46; Nevertheless&#44; because some patients with positive donor&#47; transport fluid cultures required intravenous antibiotic treatment&#44; these events were recorded as inhospital infection cases for the purpose of our database&#46; We observed that patients not discharge early had a significantly higher inhospital infection rates&#44; probably because surrogate markers of infection such as prolonged surgery&#44; higher BPC&#44; ACR events were also present in these patients&#46; Moreover&#44; applying the ERDALT scoring might identify patients less prone to develop ACR events or hospital re-admissions&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">Almost all previously published reports have focused on predictors of prolonged LOS and not on early discharge from hospital after LT&#46; In a recent report from UNOS data&#44; short LOS definition was set at &#60; 11 days&#59;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> authors referred ROC predictive value was poor in different models for assessing LOS after LT&#44; including short LOS &#40;ROC 0&#46;56-0&#46;70&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Our predictive model for ERDALT&#44; on the other hand&#44; showed a good accuracy&#44; with a c-statistic &#62; 0&#46;80&#44; moderate sensitivity &#40;70&#37;&#41; and high specificity &#40;82&#37;&#41; with the best cut-off at &#8805; 3 points&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">Finally&#44; limited information on LT costs is available for South America since MELD score policy implementation&#46; Argentina was the second country in the world to adopt this organ allocation policy in July 2005&#46; Albeit&#44; waiting list mortality has been reduced in our country&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> it has not been explored if higher MELD score recipients may promote higher LT costs&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Financial charges for LT in our country are around &#36;30&#44;000-35&#44;000&#46; Liver transplant inpatient costs in the United States have been estimated to range between &#36;80&#44;000 and &#36;114&#44;300&#44; with mean hospital charges of &#36;358&#44;200&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> If such prices were applied in Argentina&#44; access to LT would be extremely limited&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">Certain limitations to our findings merit mention&#46; First&#44; ERDALT was artificially defined with a cut-off point of 8 days of LOS&#46; We thought that a good definition for early discharge form hospital after LT was the time point of 1 week&#44; as was suggested in the literature&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> considering that median LOS was 14&#46;5 days&#46; Second&#44; overall LT costs calculation is still a complex issue&#46; We tried to reduce any errors and misleading cost analysis including every data&#44; as objective markers of resource utilization&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Finally&#44; we acknowledge that no scoring system is perfect and an external validation cohort for our model is needed&#46; Therefore&#44; this scoring model should be used along with clinical judgment in deciding whether to early discharge patients after LT&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">With respect to future planning processes based on the ERDALT score&#44; we will attempt to fast-track the immunosuppression regimes in LT recipients with ERDALT scores &#8805; 3 points&#44; to avoid treatment delays while waiting for therapeutic CNI trough levels&#44; which can be attained during outpatient follow up&#46; Furthermore&#44; for patients presenting ERADLT score &#8805; 3 points we hope to limit admission to ICU to less than 24 h&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">In summary&#44; our data suggests that early discharge from hospital following LT is feasible&#46; More importantly&#44; it does not have a negative impact on patient or graft survival&#44; nor did increase shortterm re-hospitalization or ACR rates after discharge&#46; We are now implementing our predictive model in order to help us to prepare patients and their families better for the post-transplant period and improve their expectations&#46; We believe the model has already contributed to immediate post-LT early discharge planning&#44; helping fast-track LT recipients to avoid ICU or prolonged hospitalization&#46;</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Abbreviations</span><p id="p0155" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">&#8226;</span><p id="p0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ACR&#58;</span> acute cellular rejection events&#46;</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AMV&#58;</span> assisted mechanical ventilation&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AUROC&#58;</span> Area Under Receiver Operating Characteristics&#46;</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">BMI&#58;</span> body mass index&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">BPC&#58;</span> blood product consumption&#46;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CI&#58;</span> confidence interval&#46;</p></li><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CIT&#58;</span> cold ischemia time&#46;</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DRI&#58;</span> donor risk index&#46;</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCC&#58;</span> hepatocellular carcinoma&#46;</p></li><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HE&#58;</span> hepatic encephalopathy&#46;</p></li><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ICU&#58;</span> Intensive Care Unit&#46;</p></li><li class="elsevierStyleListItem" id="u0060"><span class="elsevierStyleLabel">&#8226;</span><p id="p0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">INR&#58;</span> international normalized ratio&#46;</p></li><li class="elsevierStyleListItem" id="u0065"><span class="elsevierStyleLabel">&#8226;</span><p id="p0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">IQR&#58;</span> interquartile range&#46;</p></li><li class="elsevierStyleListItem" id="u0070"><span class="elsevierStyleLabel">&#8226;</span><p id="p0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LDLT&#58;</span> living donor liver transplantation&#46;</p></li><li class="elsevierStyleListItem" id="u0075"><span class="elsevierStyleLabel">&#8226;</span><p id="p0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LOS&#58;</span> length of hospital stay&#46;</p></li><li class="elsevierStyleListItem" id="u0080"><span class="elsevierStyleLabel">&#8226;</span><p id="p0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LT&#58;</span> liver transplantation&#46;</p></li><li class="elsevierStyleListItem" id="u0085"><span class="elsevierStyleLabel">&#8226;</span><p id="p0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MELD&#58;</span> Model for End-stage Liver Disease&#46;</p></li><li class="elsevierStyleListItem" id="u0090"><span class="elsevierStyleLabel">&#8226;</span><p id="p0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NAFLD&#58;</span> non-alcoholic fatty liver disease&#46;</p></li><li class="elsevierStyleListItem" id="u0095"><span class="elsevierStyleLabel">&#8226;</span><p id="p0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">OR&#58;</span> odds ratio&#46;</p></li><li class="elsevierStyleListItem" id="u0100"><span class="elsevierStyleLabel">&#8226;</span><p id="p0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ROC&#58;</span> receiving operator curve analysis&#46;</p></li><li class="elsevierStyleListItem" id="u0105"><span class="elsevierStyleLabel">&#8226;</span><p id="p0260" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">RRT&#58;</span> renal replacement therapy&#46;</p></li><li class="elsevierStyleListItem" id="u0110"><span class="elsevierStyleLabel">&#8226;</span><p id="p0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SBP&#58;</span> spontaneous bacterial peritonitis&#46;</p></li><li class="elsevierStyleListItem" id="u0115"><span class="elsevierStyleLabel">&#8226;</span><p id="p0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">UNOS&#58;</span> United Network for Organ Sharing&#46;</p></li></ul></p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Grants and Financial Support &#38; Conflicts of Interest</span><p id="p0275" class="elsevierStylePara elsevierViewall">All authors of this manuscript have not received any grant or funding from agencies in the public&#44; commercial&#44; or not-for-profit sectors and have no conflicts of interest to disclose as described by the <span class="elsevierStyleItalic">Annals of Hepatology Journal&#46;</span></p></span><span id="s0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Acknowledgments</span><p id="p0280" class="elsevierStylePara elsevierViewall">We thank C Podesta for her assistance with editing this paper&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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        0 => array:3 [
          "identificador" => "xres1199877"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abs0010"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1118313"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "s0005"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "s0010"
          "titulo" => "Material and Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "s0015"
              "titulo" => "Length of hospital stay after liver transplantation"
            ]
            1 => array:2 [
              "identificador" => "s0020"
              "titulo" => "Economic analysis"
            ]
            2 => array:2 [
              "identificador" => "s0025"
              "titulo" => "Endpoints&#47;Definitions"
            ]
            3 => array:2 [
              "identificador" => "s0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        4 => array:3 [
          "identificador" => "s0035"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "s0040"
              "titulo" => "Demographic characteristics and clinical data"
            ]
            1 => array:2 [
              "identificador" => "s0045"
              "titulo" => "Patients with early discharge from hospital after liver transplantation"
            ]
            2 => array:2 [
              "identificador" => "s0050"
              "titulo" => "Survival analysis&#44; liver transplant costs and re-hospitalization rates"
            ]
            3 => array:2 [
              "identificador" => "s0055"
              "titulo" => "Predictive variables for early discharge from hospital after liver transplantation"
            ]
          ]
        ]
        5 => array:2 [
          "identificador" => "s0060"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "s0065"
          "titulo" => "Abbreviations"
        ]
        7 => array:2 [
          "identificador" => "s0070"
          "titulo" => "Grants and Financial Support &#38; Conflicts of Interest"
        ]
        8 => array:2 [
          "identificador" => "s0075"
          "titulo" => "Acknowledgments"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-02-23"
    "fechaAceptado" => "2015-04-20"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1118313"
          "palabras" => array:4 [
            0 => "Health care"
            1 => "Hospital stay"
            2 => "Transplant"
            3 => "Resources"
          ]
        ]
      ]
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    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Background &#38; rationale&#46;</span> Limited information related to Liver Transplantation &#40;LT&#41; costs in South America exists&#46; Additionally&#44; costs analysis from developed countries may not provide comparable models for those in emerging economies&#46; We sought to evaluate a predictive model of Early Discharge from Hospital after LT &#40;ERDALT &#61; length of hospital stay &#8804; 8 days&#41;&#46; A predictive model was assessed based on the odds ratios &#40;OR&#41; from a multivariate regression analysis in a cohort of consecutively transplanted adult patients in a single center from Argentina and internally validated with bootstrapping technique&#46;</p><p id="sp0140" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results&#46;</span> ERDALT was applicable in 34 of 289 patients &#40;11&#46;8&#37;&#41;&#46; Variables independently associated with ERDALT were MELD exception points OR 1&#46;9 &#40;P &#61; 0&#46;04&#41;&#44; surgery time &#60; 4 h OR 3&#46;8 &#40;P &#61; 0&#46;013&#41;&#44; &#60; 5 units of blood products consumption &#40;BPC&#41; OR 3&#46;5 &#40;P &#61; 0&#46;001&#41; and early weaning from mechanical intubation OR 6&#46;3 &#40;P &#61; 0&#46;006&#41;&#46; Points in the predictive scoring model were allocated as follows&#58; MELD exception points &#40;absence &#61; 0 points&#44; presence &#61; 1 point&#41;&#44; surgery time &#60; 4 h &#40;0-2 points&#41;&#44; &#60; 5 units of BPC &#40;0-2 points&#41;&#44; and early weaning &#40;0-3 points&#41;&#46; Final scores ranged from 0 to 8 points with a c-statistic of 0&#46;83 &#40;95&#37; CI 0&#46;77-0&#46;90&#59; P &#60; 0&#46;0001&#41;&#46; Transplant costs were significantly lower in patients with ERDALT &#40;median &#36;23&#44;078 <span class="elsevierStyleItalic">vs&#46;</span> &#36;28&#44;986&#59; P &#60; 0&#46;0001&#41;&#46; Neither lower patient and graft survival&#44; nor higher rates of short-term re-hospitalization and acute rejection events after discharge were observed in patients with ERDALT&#46; In conclusion&#44; the ERDALT score identifies patients suitable for early discharge with excellent outcomes after transplantation&#46; This score may provide applicable models particularly for emerging economies&#46;</p></span>"
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          "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan Meier patient &#40;<span class="elsevierStyleBold">A</span>&#41; and graft &#40;<span class="elsevierStyleBold">B</span>&#41; 3-year survival comparative analysis between patients with and without early discharge from hospital after liver transplantation&#46; Kaplan Meier curves revealed significant differences on 3-year patient and graft survival rates between patients with and without ERDALT &#40;97&#46;1 <span class="elsevierStyleItalic">vs&#46;</span> 79&#46;2&#37;&#44; respectively&#59; P &#61; 0&#46;021&#44; and 91&#46;2&#37; <span class="elsevierStyleItalic">vs&#46;</span> 74&#46;5&#37;&#44; P &#61; 0&#46;05&#44; log rank test&#44; respectively&#41;&#46; ERDALT&#58; early discharge from hospital after liver transplantation&#46; LT&#58; liver transplantation&#46;</p>"
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        "etiqueta" => "Figure 2"
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        "mostrarFloat" => true
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Concordance statistic of predictive score for early discharge after liver transplantation &#40;ERDALT&#41;&#46; A predictive ERDALT score was calculated &#91;AUROC of 0&#46;83 &#40;CI 0&#46;77-0&#46;90&#44; P &#60; 0&#46;0001&#41;&#44; 67&#37; sensitivity and 82&#37;&#37; specificity for a cut-off &#8805; 3 points&#93;&#46; Parameters assigned points included&#58; pre-LT supplementary exception MELD points 1 point&#44; surgery time &#60; 4 h 2 points&#44; &#60; 5 units of BPC 2 points&#44; and early weaning from AMV 3 points&#46; AMV&#58; assisted mechanical ventilation&#46; AUROC&#58; area under receiver operating characteristic&#46; BPC&#58; total blood product consumption&#46; CI&#58; confidence interval&#46; LT&#58; liver transplantation&#46; PPV&#58; positive predictive value&#46; OR&#58; odds ratio&#46; NVP&#58; negative predictive value&#46;</p>"
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Correlation between points allotted in the predictive model and possibility of early discharge from hospital after liver transplantation&#46; Probability of ERDALT increased progressively as scores went from 0-1 to 2-3&#44; 4-5 to 6-8 points in the following percentages&#58; 0&#46;9&#37; &#40;n &#61; 1&#47;116&#41;&#44; 9&#46;7&#37; &#40;n &#61; 10&#47;103&#41;&#44; 19&#46;0&#37; &#40;n &#61; 8&#47;42&#41;&#44; and 53&#46;4&#37; &#40;n &#61; 15&#47;28&#41;&#44; respectively &#40;Goodman &#38; Kruskall Gamma P &#61; 0&#46;0001&#41;&#46;</p>"
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        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">A clinical nomogram for early discharge from hospital after liver transplantation <span class="elsevierStyleBold">&#40;A&#41;&#46;</span> Possible clinical scenarios and application <span class="elsevierStyleBold">&#40;B&#41;&#46;</span> A clinical nomogram was constructed based on presence or absence of each risk variable to simplify scoring&#46; ERDALT event percentages shown&#46;</p>"
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        "etiqueta" => "Table 1"
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        "tabla" => array:2 [
          "leyenda" => "<p id="np0005" class="elsevierStyleSimplePara elsevierViewall">LT&#58; liver transplantation&#46; LDLT&#58; living donor liver transplantation&#46; MELD&#58; Model for End Stage Liver Disease&#46; NAFLD&#58; non-alcoholic fatty liver disease&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Age&#44; years&#44; &#177; SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#177; 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender&#58;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">male&#47;female&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168 &#40;58&#46;1&#41;&#47;121 &#40;41&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD&#44; &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#177; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Etiology&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;21&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alcoholic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cryptogenic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Autoimmune&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;15&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cholestatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NAFLD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Miscellaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;12&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute liver failure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Re-transplantation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kidney-LT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDLT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Supplementary MELD points&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;18&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatocellular carcinoma&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;14&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensive Care Unit pre-LT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Renal replacement therapy pre-LT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Donor age&#44; years&#44; &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#177; 16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cold ischemia time&#44; minutes&#44; &#177; SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">443 &#177; 150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2049642.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Patients&#8217; demographic and baseline characteristics&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "t0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="np0010" class="elsevierStyleSimplePara elsevierViewall">ERDALT&#58; early discharge from hospital after liver transplantation&#46; LT&#58; liver transplantation&#46; LDLT&#58; living donor liver transplantation&#46; MELD&#58; Model for End Stage Liver Disease&#46; SBP&#58; spontaneous bacterial peritonitis&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ERDALT n &#61; 34 &#40;11&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No ERDALT n &#61; 255 &#40;88&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Odds ratio &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre transplant variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes mellitus&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8 &#40;0&#46;31-2&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute liver failure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6 &#40;0&#46;12-2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Re-transplantation&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;20-4&#46;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kidney-LT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;84-1&#46;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LDLT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;8&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;83-1&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MELD &#60; 15&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;58&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;39&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;2 &#40;1&#46;07-4&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Supplementary MELD&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;47&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;1 &#40;2&#46;38-10&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe ascites&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;23&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109 &#40;43&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#40;0&#46;17-0&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variceal bleeding&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5 &#40;0&#46;16-1&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;26&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#40;0&#46;12-1&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatic encephalopathy&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;11&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;24&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4 &#40;0&#46;14-1&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Portal vein thrombosis&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6 &#40;0&#46;14-2&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abdominal surgery&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;32&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4 &#40;0&#46;65-3&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatocellular carcinoma&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;23&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1 &#40;0&#46;86-4&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intensive Care Unit&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;20&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1 &#40;0&#46;01-0&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RRT&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8 &#40;0&#46;83-1&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Post transplant variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LT surgery time &#60; 4 h&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5 &#40;2&#46;27-13&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 5 BPC&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;52&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;4 &#40;3&#46;45-15&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early weaning AMV&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;91&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126 &#40;49&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5 &#40;3&#46;13-35&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Donor&#47;Graft &#43; cultures&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;13&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;6 &#40;0&#46;25-1&#46;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\t\t</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#946;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bootstrapping &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exception MELD points<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;9 &#40;1&#46;09-4&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;06 - 4&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">LT surgery time &#60;4 h<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;8 &#40;1&#46;34-10&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;10 - 14&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 5 BPC<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#40;1&#46;47-8&#46;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;45 - 8&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Early weaning AMV<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3 &#40;1&#46;75-22&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;25 - 19&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comments&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Points&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Exception MELD points<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Absence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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Article information
ISSN: 16652681
Original language: English
DOI:10.5604/16652681.1171770
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