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=> array:3 [ "entidad" => "Unidad de Cirugía HB y Trasplante Hepático, Servicio de Cirugía, Hospital Universitari Bellvitge, IDIBELL, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cirugía HBP y Trasplante de Órganos, Servicio de Cirugía, Hospital Universitario 12 de Octubre, Imas12, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Anestesiología, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Anestesiología-Reanimación, Hospital Universitario de Cruces, Bilbao, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Cirugía HBP y Trasplante, Hospital Universitario y Politécnico La Fe, Universitat de València, CIBERehd, ISCIII, IIS LaFe, Valencia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidad Hepática, Servicio de Digestivo, CIBERehd, ISABIAL, Hospital General Universitario Alicante, Alicante, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Unidad Hepática, Servicio de Cirugía, CIBERehd, ISABIAL, Hospital General Universitario Alicante, Alicante, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Documento de consenso de la Sociedad Española de Trasplante Hepático. Recuperación intensificada en trasplante hepático" ] ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 488 "Ancho" => 1333 "Tamanyo" => 89557 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0085" class="elsevierStylePara elsevierViewall">The 2021 ERAS (Enhanced Recovery After Surgery) guidelines define the general measures designed to optimize rehabilitation or postoperative recovery by reducing surgical complications and improving the perceived quality of life of patients undergoing abdominal surgery.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The implementation of ERAS programs in the context of liver transplantation (LT) has not been widely developed. In Spain, it is the intention of the Spanish Society of Liver Transplantation (<span class="elsevierStyleItalic">Sociedad Española de Trasplante Hepático</span>, or SETH) to promote these protocols, and the initial step is to reach a consensus on the measures to be implemented in LT programs.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="par0095" class="elsevierStylePara elsevierViewall">In September 2022, the SETH created a multidisciplinary working group that included surgeons, hepatologists and anesthesiologists who specialize in LT. Our aim was to review the current evidence regarding elements that favor better, faster patient recovery after LT and criteria for early and safe discharge, while guaranteeing maximum safety. Three periods were established— pre-transplantation, intraoperative, and post-transplantation — following the same criteria as other consensus documents from the same society.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The review of the literature provided the points to be debated, which were compiled in a draft and distributed among the 26 representatives of the national LT groups.</p><p id="par0105" class="elsevierStylePara elsevierViewall">We followed the modified Delphi method<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and consulted the following sources: MEDLINE, PubMed, and sources from different scientific societies involved in transplantation and hepatology, using the terms [“liver transplantation” or “cirrhosis” ] AND [“education”, “safe discharge”, “nutrition”, “sarcopenia”, “prehabilitation”, “fast-track”, “ERAS”]. The preliminary list of recommendations was submitted to all groups for debate; if 75% agreement was not reached, the recommendation was again discussed. The final version of the document only included recommendations that reached a consensus of 75%, which was then redistributed among the group representatives for final comments and approval (second Delphi round).</p><p id="par0110" class="elsevierStylePara elsevierViewall">The scientific evidence and grade of recommendation were established following the 2 dimensions of the GRADE system<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> — Quality of the evidence: (A) high; (B) moderate; (C) low; and Strength of the recommendation: (1) strong; (2) weak.</p><p id="par0115" class="elsevierStylePara elsevierViewall">This document contains the conclusions reached at the 10th SETH Consensus Meeting in November 2022, with representatives from all LT groups in Spain.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Prior to describing the evidence evaluated and the consequent recommendations, it was necessary to agree on the objectives and criteria for safe, early discharge<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), as well as the indicators of the ERAS program.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The working group identified the following basic indicators to evaluate the results and compare the different pre-, intra- and postoperative elements: length of hospital stay and Intensive Care Unit (ICU) stay, rate of complications, intrahospital mortality, ICU readmission rate, hospital readmission rate, and ERAS protocol compliance rate.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Evidence and recommendations for the implementation of the ERAS program in LT</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pre-operative period (Prehabilitation)</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Prehabilitation: pre-transplant education</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Does pre-transplant education influence postoperative evolution?</span><p id="par0130" class="elsevierStylePara elsevierViewall">There are no consensus guidelines about the instructions and information that should be given to patients who are candidates for LT. However, factors like nutrition, immunosuppression, and glycemic control must be discussed before adding the patient to the transplant list. To facilitate compliance with the objectives, the 2021 ERAS clinical guidelines recommend that this information be addressed not only to the patient but also their immediate family or caretakers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a></p></span></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Recommendation</span><p id="par0135" class="elsevierStylePara elsevierViewall">All patients who are candidates for LT must receive information and instructions before/upon being added to the waiting list in order to actively participate in their recovery process. Evidence/Recommendation: C1</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Intervention proposals</span><p id="par0140" class="elsevierStylePara elsevierViewall">The patient is provided detailed information by specialized staff before being added to the waiting list. To this end, a “check-list” could be prepared previously and then reviewed with the patient and family members/caretaker (example in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Informative workshops should be created for patients with recent transplants or those on the waiting list, which would be taught by former transplant recipients and medical staff who work in the LT program.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Prehabilitation: physical exercise</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Can a physical prehabilitation program help improve immediate recovery after LT surgery?</span><p id="par0150" class="elsevierStylePara elsevierViewall">Any improvement in the functional capacity of patients awaiting LT using training and physical exercise programs could influence the postoperative period in the short and medium term, while also improving the recovery of patients after surgery.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, there is no scientific evidence regarding the possible impact of physical prehabilitation on short-term benefits after transplantation.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Recommendation</span><p id="par0155" class="elsevierStylePara elsevierViewall">Although there is no evidence regarding the benefits of a physical exercise program, it is considered non-detrimental and safe. Evidence/Recommendation: C2</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Proposed intervention</span><p id="par0160" class="elsevierStylePara elsevierViewall">In previously selected patients, schedule physical prehabilitation before transplantation in an individualized manner, using nutritional assessment and the application of indices to assess the frailty of these patients. These activities should be proposed and directed by specialists in rehabilitation and physiotherapy.</p><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Prehabilitation: nutrition</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Can systematic nutritional assessment help improve immediate recovery after LT surgery? Could a nutritional intervention in selected patients improve/accelerate recovery after LT surgery?</span><p id="par0165" class="elsevierStylePara elsevierViewall">The revision of the ILTS consensus was not conclusive in establishing the role of nutritional support before transplantation in the short-term results after surgery.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The studies analyzed demonstrated no influence on mortality or the rate of complications (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–13</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Recommendation</span><p id="par0170" class="elsevierStylePara elsevierViewall">The benefits of a supplemental nutritional intervention have not been demonstrated in standard patients. Vitamin D supplements should follow the recommendations given for the general population. The intervention is considered non-detrimental. Evidence/Recommendation: C2</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Proposed intervention</span><p id="par0175" class="elsevierStylePara elsevierViewall">Nutritional assessment is proposed in all patients who are candidates for LT, and the intervention should be considered in patients whose parameters indicate they are either malnourished or overweight. These activities should be proposed and directed by specialists in endocrinology and nutrition.</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Assessment of patients at risk</span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Are there validated scores that allow us to predict better, faster recovery after LT surgery?</span><p id="par0180" class="elsevierStylePara elsevierViewall">There are no validated scores that make it possible to reliably predict the probability of post-LT complications.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The scores that present some relationship with outcome parameters (such as ICU/hospital stay) are those that evaluate factors like physical function (frailty and performance status) and sarcopenia (<a class="elsevierStyleCrossRefs" href="#tbl0020">Tables 4 and 5</a>).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–23</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Levels of evidence of pre-LT assessment scores:</span></p><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Karnofsky Performance Status</span> — Evidence/Recommendation: B2</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Liver Frailty Index</span> — Evidence/Recommendation: B1</p><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Fried Frailty Index</span> — Evidence/Recommendation: C2</p><p id="par0205" class="elsevierStylePara elsevierViewall">Measurement of muscle mass using the psoas muscle mass index/total skeletal muscle mass index on L3-L4 computed tomography — Evidence/Recommendation: B1</p></span></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Recommendation</span><p id="par0210" class="elsevierStylePara elsevierViewall">The evaluation of frailty is mandatory for the assessment of patients who are candidates for LT — Evidence/Recommendation: B1</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Proposed intervention</span><p id="par0215" class="elsevierStylePara elsevierViewall">A frailty evaluation should be included in the initial assessment of patients who are candidates for LT, and appropriate measures should be adopted based on the results. The recommended scores are those that have a higher degree of evidence in the literature (Karnofsky Performance Status, Liver Frailty Index [in outpatients] and sarcopenia [in hospitalized patients]).</p><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Prehabilitation: pre-transplant anemia control</span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Does preoperative anemia control influence recovery after LT?</span><p id="par0220" class="elsevierStylePara elsevierViewall">The diverse nature of liver disease, the frequently associated portal hypertension, and the unpredictability of waiting list times are obstacles in the control of pre-transplant anemia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,24–27</span></a></p></span></span></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Recommendation</span><p id="par0225" class="elsevierStylePara elsevierViewall">An attempt should be made to obtain/maintain adequate hemoglobin (Hb) levels during the waiting list period before the day of the transplant. Hb levels of no less than 10 g/dL are considered optimal. Evidence/Recommendation: B1</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Proposed intervention</span><p id="par0230" class="elsevierStylePara elsevierViewall">A preoperative patient blood-management program should be developed, and a periodic screening system should be established; target figures should never be less than 10 g/dL, regardless of gender, and anemia treatment measures should be programmed.</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Intraoperative period</span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Anesthetic management</span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">What is the optimal anesthesia that manages to improve the immediate and short-term results after LT?</span><p id="par0235" class="elsevierStylePara elsevierViewall">Propofol is associated with faster awakening time and less ischemia-reperfusion injury. Some studies show a greater risk of atelectasis, cardiac injury markers and mortality with the use of high O<span class="elsevierStyleInf">2</span> concentrations. Low tidal volume ventilation in abdominal surgery is associated with reduced mortality. A specific range of positive end-expiratory pressure (PEEP) cannot be recommended, but recruitment maneuvers improve oxygenation and lung function.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The benefit/risk ratio of antiemetic prophylaxis is favorable.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p></span></span></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Recommendations</span><p id="par0240" class="elsevierStylePara elsevierViewall">The use of volatile hypnotic agents is recommended, except in patients at risk of intracranial hypertension. Evidence/Recommendation: C2</p><p id="par0245" class="elsevierStylePara elsevierViewall">The use of the minimum alveolar concentration (MAC) is recommended to measure the depth of anesthesia. Evidence/Recommendation: C2</p><p id="par0250" class="elsevierStylePara elsevierViewall">It is recommended to use inspiratory oxygen concentrations (FiO<span class="elsevierStyleInf">2</span>) aimed at maintaining PO<span class="elsevierStyleInf">2</span> in the range of 70−110 mmHg, tidal volumes between 6−8 mL/kg, and recruitment maneuvers. Evidence/Recommendation: C1</p><p id="par0255" class="elsevierStylePara elsevierViewall">The routine use of antiemetics is recommended. Evidence/Recommendation: C1</p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Proposed intervention</span><p id="par0260" class="elsevierStylePara elsevierViewall">Anesthetic measures that have been reported to improve results after anesthesia (with lower morbidity and mortality rates) should be standardized.</p><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">What is the optimal method of anesthetic monitoring that improves immediate and short-term results after LT?</span><p id="par0265" class="elsevierStylePara elsevierViewall">Insertion of a transesophageal echocardiogram probe is considered safe in patients with esophageal varices under treatment, as long as variceal ligation has not been performed within the previous 30 days. Hemodynamic monitoring systems based on pulse wave analysis are not useful in patients with advanced liver disease.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Recommendations</span><p id="par0270" class="elsevierStylePara elsevierViewall">Routine monitoring of invasive blood pressure and central venous pressure is recommended. Evidence/Recommendation: C1</p><p id="par0275" class="elsevierStylePara elsevierViewall">Systematic ultrasound-guided placement of a high-flow central or peripheral venous catheter under sterile conditions is recommended. Evidence/Recommendation: C1</p><p id="par0280" class="elsevierStylePara elsevierViewall">Monitoring with a pulmonary artery catheter and/or transesophageal echocardiography is recommended in unstable patients and those with high surgical risk and/or known pulmonary hypertension or ventricular dysfunction. Evidence/Recommendation: C1</p><p id="par0285" class="elsevierStylePara elsevierViewall">Transesophageal echocardiography should not be used in patients with a history of variceal ligation in the 30 days prior to transplantation. Evidence/Recommendation: C1</p><p id="par0290" class="elsevierStylePara elsevierViewall">Maintained normothermia is recommended during surgery. Evidence/Recommendation: C1</p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Proposed intervention</span><p id="par0295" class="elsevierStylePara elsevierViewall">Systematic use of a transesophageal echocardiography probe in all patients who do not have contraindications in order to acquire a level of knowledge appropriate for this clinical context.</p><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">How do intraoperative transfusion management, antifibrinolytic therapy, and coagulation monitoring influence immediate and short-term results after LT?</span><p id="par0300" class="elsevierStylePara elsevierViewall">Hypervolemia temporarily increases the degree of portal hypertension, which increases the risk of bleeding. Patients with chronic liver disease are at a higher risk of developing acute renal failure with the administration of colloids. Viscoelastic tests have been shown to reduce transfusion requirements in the context of bleeding compared to standard coagulation tests. Prophylactic transfusion of blood products has not been shown to be effective to reduce bleeding.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31,32</span></a></p></span></span><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Recommendations</span><p id="par0305" class="elsevierStylePara elsevierViewall">A moderately restrictive fluid administration regimen is recommended. Evidence/Recommendation: C1</p><p id="par0310" class="elsevierStylePara elsevierViewall">The use of 6% 130/0.44 HES is not recommended in patients with chronic liver disease.</p><p id="par0315" class="elsevierStylePara elsevierViewall">Evidence/Recommendation: C1</p><p id="par0320" class="elsevierStylePara elsevierViewall">It is recommended to maintain mean blood pressure values above 60−65 mmHg Evidence/Recommendation: C1</p><p id="par0325" class="elsevierStylePara elsevierViewall">In the case of active bleeding (not massive bleeding), there is no evidence to recommend a specific ratio of blood products. Evidence/Recommendation: B1</p><p id="par0330" class="elsevierStylePara elsevierViewall">The use of a cell saver is recommended. Evidence/Recommendation: B1</p></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Proposed intervention</span><p id="par0335" class="elsevierStylePara elsevierViewall">Pursue a moderately restrictive fluid approach during the perioperative period, strictly monitoring renal function and peripheral perfusion markers.</p><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">What is the role of early extubation in the immediate and short-term results after liver transplantation?</span><p id="par0340" class="elsevierStylePara elsevierViewall">There is no consensus on the definition of early extubation. The definitions used in studies range from extubation in the operating room to the first 24 h post-transplant.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p></span></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Recommendations</span><p id="par0345" class="elsevierStylePara elsevierViewall">Early extubation is recommended in all patients where this is possible, given the lower incidence of reintubation, pulmonary complications, shorter ICU stay, and shorter hospital stay. Evidence/Recommendation: C1</p></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Proposed intervention</span><p id="par0350" class="elsevierStylePara elsevierViewall">Standardize the definition of early extubation to demonstrate causality and to validate and compare short-term results.</p><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">What is the role of perioperative analgesia in the immediate and short-term results after LT?</span><p id="par0355" class="elsevierStylePara elsevierViewall">Non-opioid analgesics have been shown to be superior to conventional opioid analgesia for the outcomes of postoperative pain, extubation time, intensive care unit stay, hospital stay, and mortality.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Recommendations</span><p id="par0360" class="elsevierStylePara elsevierViewall">It is recommended to minimize the use of opioids in postoperative analgesia. Evidence/Recommendation: B2</p><p id="par0365" class="elsevierStylePara elsevierViewall">The use of acetaminophen (paracetamol), gabapentin, ketamine, and local anesthetics is recommended instead of (or to complement) opioids for postoperative analgesia. Evidence/Recommendation: B2</p></span><span id="sec0205" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0235">Proposed intervention</span><p id="par0370" class="elsevierStylePara elsevierViewall">Standardize opioid-free multimodal analgesic regimens, which can be evaluated and compared with conventional opioid analgesia.</p><span id="sec0210" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0240">Surgical technique</span><span id="sec0215" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0245">What type of surgical technique manages to improve immediate and short-term results after LT?</span><p id="par0375" class="elsevierStylePara elsevierViewall">The choice of a certain surgical technique can provide patient benefits, depending on their hemodynamic clinical situation, in terms of intraoperative management and early postoperative recovery. In general, the level of evidence to evaluate these factors is low or very low.<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">1</span><p id="par0380" class="elsevierStylePara elsevierViewall">Hepatectomy technique (cava replacement vs piggy-back technique): The piggy-back technique shortens the duration of the operation and entails less intraoperative transfusion. There are no differences for other parameters.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">2</span><p id="par0385" class="elsevierStylePara elsevierViewall">Use of veno-venous by-pass: Even though veno-venous bypass prolongs the surgical intervention and increases transfusion, its use entails reduced cardiovascular instability in patients without collateral portosystemic circulation. However, to minimize technical complications, it is recommended that the anesthetic and surgical team be familiar with its use.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">3</span><p id="par0390" class="elsevierStylePara elsevierViewall">Portacaval shunting: Portacaval shunting has shown beneficial intraoperative effects in cases of elevated basal portal flow (≥1000 mL/min) and/or portacaval pressure gradient ≥16 mmHg, with fewer transfused blood units and shorter operation times.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p></li></ul></p></span></span></span><span id="sec0220" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0250">Recommendations</span><p id="par0395" class="elsevierStylePara elsevierViewall">The surgical technique chosen for the type of cava anastomosis (cava substitution vs piggy-back) should be based on the preferences of each hospital and surgical team. One technique cannot be recommended over another in a systematic manner. Evidence/Recommendation: C1</p><p id="par0400" class="elsevierStylePara elsevierViewall">Veno-venous bypass may be considered in certain situations. It is recommended that the anesthesia/surgery team and the organization be familiar with the technique. Evidence/Recommendation: C1</p><p id="par0405" class="elsevierStylePara elsevierViewall">The temporary portacaval shunt is recommended in cases of severe portal hypertension. Evidence/Recommendation: B1</p></span><span id="sec0225" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0255">Proposed intervention</span><p id="par0410" class="elsevierStylePara elsevierViewall">Identify the hemodynamic and anatomical situation of each recipient (portal flow and degree of portal hypertension, presence of portosystemic circulation, inferior vena cava gradient, hepatomegaly) to indicate the surgical technique that benefits intraoperative anesthetic-surgical management.</p><span id="sec0230" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0260">Do immediate and short-term results after LT improve with the placement of abdominal drain tubes, T-tube in the bile duct, NG tube, skin preparation or incision type?</span><p id="par0415" class="elsevierStylePara elsevierViewall">It is recommended to avoid the routine use of drain tubes and catheters. When used, early removal is recommended. The level of evidence is very low due to the lack of randomized prospective studies with sufficient sample size.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37–42</span></a></p></span></span><span id="sec0235" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0265">Recommendations</span><p id="par0420" class="elsevierStylePara elsevierViewall">The use of the surgical checklist is recommended for the prevention of adverse events and mortality related to the intervention. Evidence/Recommendation: B1</p><p id="par0425" class="elsevierStylePara elsevierViewall">Routine nasogastric tube placement is not recommended. Evidence/Recommendation: A1</p><p id="par0430" class="elsevierStylePara elsevierViewall">There is insufficient evidence to recommend the routine use of abdominal drain tubes. Open drain systems should be avoided due to the greater risk of infection. Evidence/Recommendation: C2</p><p id="par0435" class="elsevierStylePara elsevierViewall">Early removal of drain tubes is recommended (before the 5th postoperative day), depending on the amount and appearance of the drained fluid. Evidence/Recommendation: B1</p><p id="par0440" class="elsevierStylePara elsevierViewall">Routine/systematic placement of a T-tube is not recommended. Its use could be beneficial in cases of high risk of biliary stenosis. Evidence/Recommendation: C1</p><p id="par0445" class="elsevierStylePara elsevierViewall">Early removal of the central line and urinary catheter is recommended to reduce catheter infections. Evidence/Recommendation: C1</p><p id="par0450" class="elsevierStylePara elsevierViewall">The type of incision used is left to the discretion of the surgeon. Evidence/Recommendation: B1</p></span><span id="sec0240" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0270">Proposed intervention</span><p id="par0455" class="elsevierStylePara elsevierViewall">In all cases, systematic collection of these variables is recommended to establish in the future the actual influence of their application on postoperative morbidity, mortality and hospital stay.</p><span id="sec0245" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0275">What is the role of perfusion machines in improving the immediate and short-term results of the liver graft and recipient?</span><p id="par0460" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">a)</span><p id="par0465" class="elsevierStylePara elsevierViewall">Regional normothermic perfusion in non–heart-beating donation reduces ischemia time, provides for evaluation of the grafts, and decreases the rates of post-transplant ischemic biliary complications.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a></p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">b)</span><p id="par0470" class="elsevierStylePara elsevierViewall">Both hypothermic (HMP) and normothermic (NMP) perfusion machines have been shown to be beneficial in the prevention of post-reperfusion syndrome and primary graft dysfunction, specifically for suboptimal grafts.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p></li></ul></p></span></span><span id="sec0250" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0280">Recommendations</span><p id="par0475" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">a)</span><p id="par0480" class="elsevierStylePara elsevierViewall">The use of regional normothermic perfusion is recommended during extraction in non–heart-beating donation due to its beneficial effect on the initial graft function. Evidence/Recommendation: C1</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">b)</span><p id="par0485" class="elsevierStylePara elsevierViewall">It is recommended to assess the role of dynamic preservation with <span class="elsevierStyleItalic">ex situ</span> perfusion machines in suboptimal grafts. Evidence/Recommendation: C1</p></li></ul></p></span><span id="sec0255" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0285">Proposed intervention</span><p id="par0490" class="elsevierStylePara elsevierViewall">In the extraction of donors in cardiorespiratory arrest, the use of regional normothermic perfusion (RNP) is recommended instead of super rapid extraction.</p><p id="par0495" class="elsevierStylePara elsevierViewall">Assessment of the progressive implementation of dynamic preservation with perfusion machines is recommended in order to define in which cases their use will provide benefits compared to standard perfusion.</p></span><span id="sec0260" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0290">Postoperative period</span><span id="sec0265" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0295">Post-transplant nutrition</span><span id="sec0270" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0300">Does early postoperative nutrition influence the recovery of patients undergoing LT?</span><p id="par0500" class="elsevierStylePara elsevierViewall">The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of the Liver (EASL) recommend starting nutritional intake 12−24 h after surgery to reduce the risk of complications and hospital stay after transplantation.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37,45–50</span></a></p><p id="par0505" class="elsevierStylePara elsevierViewall">The ESPEN guidelines recommend the intake of 1.2–1.5 g protein/kg of body weight in within 24 h of liver transplantation.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a></p></span></span></span><span id="sec0275" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0305">Recommended intervention</span><p id="par0510" class="elsevierStylePara elsevierViewall">Oral and/or enteral nutrition should be started 12−24 h after liver transplantation, depending on patient tolerance. The nutritional objective should emphasize achieving adequate protein intake as part of the overall energy needs. Evidence/Recommendation: C1</p><p id="par0515" class="elsevierStylePara elsevierViewall">There is no clear evidence of the benefit of nutritional supplements after LT. Evidence/Recommendation: C1</p></span><span id="sec0280" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0310">Proposed intervention</span><p id="par0520" class="elsevierStylePara elsevierViewall">Oral and/or enteral nutritional support is started within hours of transplantation.</p><p id="par0525" class="elsevierStylePara elsevierViewall">Parenteral nutrition will be reserved for patients in whom the calorie and protein intake necessary to maintain adequate nutritional status is not sufficient.</p><span id="sec0285" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0315">Postoperative rehabilitation</span><span id="sec0290" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0320">How does early mobilization and respiratory rehabilitation influence the recovery of patients undergoing LT?</span><p id="par0530" class="elsevierStylePara elsevierViewall">A recent study has shown a decrease in muscle strength and exercise tolerance at discharge after LT.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">52</span></a> The benefits of physical and respiratory rehabilitation after surgery have been demonstrated and influence factors of postoperative recovery, such as pain reduction, prevention of deep vein thrombosis and pulmonary thromboembolism, reduction in the incidence of atelectasis and respiratory complications, in addition to improvement in the psychological status of the patient.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,37,53–55</span></a></p></span></span></span><span id="sec0295" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0325">Recommendation</span><p id="par0535" class="elsevierStylePara elsevierViewall">Early mobilization should be started as soon as possible after LT.</p><p id="par0540" class="elsevierStylePara elsevierViewall">Evidence/Recommendation: B1</p><p id="par0545" class="elsevierStylePara elsevierViewall">Respiratory rehabilitation is recommended because it is safe and effective, reduces postoperative complications and improves functional results.</p><p id="par0550" class="elsevierStylePara elsevierViewall">Evidence/Recommendation: B1</p></span><span id="sec0300" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0330">Proposed intervention</span><p id="par0555" class="elsevierStylePara elsevierViewall">Establish a protocol for early mobilization and directed respiratory rehabilitation with the help of incentive spirometry in the immediate postoperative period.</p><p id="par0560" class="elsevierStylePara elsevierViewall">The patient will begin walking while hospitalized and later start physical rehabilitation after hospital discharge.</p><span id="sec0305" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0335">Vascular monitoring and thromboprophylaxis management</span><p id="par0565" class="elsevierStylePara elsevierViewall">A previous SETH<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> consensus document has established recommendations for this management.</p></span><span id="sec0310" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0340">Immunosuppression management</span><span id="sec0315" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0345">Which immunosuppressive strategy achieves better short-term results in patients undergoing LT?</span><p id="par0570" class="elsevierStylePara elsevierViewall">The implementation of an intensive pharmacokinetic monitoring program and the dose calculation based on the Bayesian estimation provide for individualized immunosuppression adjustments.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,54</span></a> Several studies have evaluated the delayed start of calcineurin inhibitors (CI) associated with induction therapies aimed at preserving renal function, with no associated increase in episodes of acute rejection.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,56</span></a></p></span></span></span><span id="sec0320" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0350">Recommendation</span><p id="par0575" class="elsevierStylePara elsevierViewall">Intensive pharmacokinetic monitoring and its adjustment by Bayesian estimation allow for early optimization of immunosuppression, favor enhanced recovery, and enable early discharge. Evidence/Recommendation: B1</p><p id="par0580" class="elsevierStylePara elsevierViewall">Immunosuppression strategies should be aimed at reducing its adverse effects. Evidence/Recommendation: B1</p><p id="par0585" class="elsevierStylePara elsevierViewall">Delayed start of immunosuppression with IC (+/− ARIL-2) can help reduce minimize its adverse effects (especially nephrotoxicity). Evidence/Recommendation: C1</p></span><span id="sec0325" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0355">Proposed interventions</span><p id="par0590" class="elsevierStylePara elsevierViewall">The use of immunosuppression regimens based on low doses or delayed introduction of tacrolimus associated with ARIL-2 induction is recommended in patients at risk of kidney injury and in combination with dual or triple therapy with corticosteroids and/or MMF.</p><span id="sec0330" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0360">Antimicrobial prophylaxis</span><span id="sec0335" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0365">What is the optimal antimicrobial prophylaxis to prevent postoperative infectious complications after liver transplantation?</span><p id="par0595" class="elsevierStylePara elsevierViewall">When selecting the appropriate antimicrobial to prevent bacterial infections, it is necessary to consider the clinical conditions of each patient, local epidemiology, and resistance patterns.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a></p></span></span></span><span id="sec0340" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0370">Recommendation</span><p id="par0600" class="elsevierStylePara elsevierViewall">Antibiotic prophylaxis against bacterial infections must be protocolized, and its duration should not routinely exceed 24 h. Evidence/Recommendation: B1</p><p id="par0605" class="elsevierStylePara elsevierViewall">The choice of antimicrobial should be individualized according to the microbiota and specific characteristics of each transplant center. Evidence/Recommendation: B1</p></span><span id="sec0345" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0375">Proposed interventions</span><p id="par0610" class="elsevierStylePara elsevierViewall">Antibiotic prophylaxis for the first 24 h after transplantation against bacterial infections with choice of antimicrobial based on local epidemiology and the presence of colonization by multi-resistant germs in the donor and/or recipient.</p><p id="par0615" class="elsevierStylePara elsevierViewall">Other factors will be considered in order to individualize the therapy regarding surgical technique and/or clinical status of the transplanted patient.</p><span id="sec0350" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0380">Post-transplant education</span><span id="sec0355" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0385">Does post-transplant education influence the clinical evolution of patients undergoing LT?</span><p id="par0620" class="elsevierStylePara elsevierViewall">Systematic education programs in the postoperative period after liver transplantation can help increase or reinforce the knowledge of patients and family members in terms of their new transplant condition. These programs should be multidisciplinary.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,37</span></a></p></span></span></span><span id="sec0360" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0390">Recommendation</span><p id="par0625" class="elsevierStylePara elsevierViewall">Systematic education in the postoperative period after liver transplantation helps reinforce the patient's knowledge of their new transplant condition. These programs continue the educational process that was begun in the preoperative period and should continue during long-term post-transplantation follow-up. Evidence/Recommendation: C1</p></span><span id="sec0365" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0395">Proposed interventions</span><p id="par0630" class="elsevierStylePara elsevierViewall">Detailed information should be offered to the patient and caregiver(s) during hospital discharge by multidisciplinary specialists (surgeon, rehabilitator, home hospitalization, advanced practical nursing). Establish a check-list model for home compliance with pharmacological treatment (especially immunosuppressants), diet and rehabilitation. (Example in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>)<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">-</span><p id="par0635" class="elsevierStylePara elsevierViewall">Mobile application for warning / resolution of unforeseen events</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">-</span><p id="par0640" class="elsevierStylePara elsevierViewall">Workshops for transplant patients given by long-term transplant patients and staff members of the LT program</p></li></ul></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span><span id="sec0370" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0400">Conclusions</span><p id="par0645" class="elsevierStylePara elsevierViewall">The recommendations of this consensus document are based on a multidisciplinary approach and the available scientific evidence, which is very limited. The recommendations are linked to a series of proposed interventions to facilitate their application. The implementation of these recommendations inescapably requires the commitment of all the members of the LT teams, as well as each institution.</p><p id="par0650" class="elsevierStylePara elsevierViewall">Each group at each transplant center will manage the options, possibilities and factors that may facilitate its implementation:<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">1</span><p id="par0655" class="elsevierStylePara elsevierViewall">Restructure resources and/or acquire new resources, if necessary.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">2</span><p id="par0660" class="elsevierStylePara elsevierViewall">Establish a registry for this activity, preferably integrated into the hospital computer system. To this end, checklists can be particularly useful.</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">3</span><p id="par0665" class="elsevierStylePara elsevierViewall">Establish an auditing system of indicators to determine compliance with the protocol and results.</p></li></ul></p></span><span id="sec0375" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0405">Authors' contribution</span><p id="par0670" class="elsevierStylePara elsevierViewall">L.L.L., M.A., A.B., R.G, E.M, S.P., G.R. han contribuido en la concepción y diseño de la revisión, han participado en la redacción del trabajo y su revisión crítica y han aprobado el contenido final. Por otra parte han actuado como coordinadores del panel de la reunión de consenso de la Sociedad Española de Trasplante Hepático.</p></span><span id="sec0380" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0410">Funding</span><p id="par0675" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies, commercial sector or non-profit entities.</p></span><span id="sec0385" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0415">Conflict of interests</span><p id="par0680" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest in relation to this work.</p></span><span id="sec0390" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0420">Acknowledgment</span><p id="par0685" class="elsevierStylePara elsevierViewall">The consensus group thanks Paloma Bellés of AOPC for her contribution with secretarial work and technical support.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2125850" "titulo" => "Graphical abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:3 [ "identificador" => "xres2125849" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 2 => array:2 [ "identificador" => "xpalclavsec1807629" "titulo" => "Keywords" ] 3 => array:2 [ "identificador" => "xpalclavsec1807630" "titulo" => "Abbreviations" ] 4 => array:3 [ "identificador" => "xres2125851" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0015" ] ] ] 5 => array:2 [ "identificador" => "xpalclavsec1807628" "titulo" => "Palabras clave" ] 6 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 7 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 8 => array:3 [ "identificador" => "sec0015" "titulo" => "Evidence and recommendations for the implementation of the ERAS program in LT" "secciones" => array:39 [ 0 => array:3 [ "identificador" => "sec0020" "titulo" => "Pre-operative period (Prehabilitation)" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0025" "titulo" => "Prehabilitation: pre-transplant education" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Does pre-transplant education influence postoperative evolution?" ] ] ] ] ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Recommendation" ] 2 => array:3 [ "identificador" => "sec0040" "titulo" => "Intervention proposals" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0045" "titulo" => "Prehabilitation: physical exercise" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Can a physical prehabilitation program help improve immediate recovery after LT surgery?" ] ] ] ] ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Recommendation" ] 4 => array:3 [ "identificador" => "sec0060" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0065" "titulo" => "Prehabilitation: nutrition" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Can systematic nutritional assessment help improve immediate recovery after LT surgery? Could a nutritional intervention in selected patients improve/accelerate recovery after LT surgery?" ] ] ] ] ] 5 => array:2 [ "identificador" => "sec0075" "titulo" => "Recommendation" ] 6 => array:3 [ "identificador" => "sec0080" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0085" "titulo" => "Assessment of patients at risk" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Are there validated scores that allow us to predict better, faster recovery after LT surgery?" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0095" "titulo" => "Recommendation" ] 8 => array:3 [ "identificador" => "sec0100" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0105" "titulo" => "Prehabilitation: pre-transplant anemia control" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0110" "titulo" => "Does preoperative anemia control influence recovery after LT?" ] ] ] ] ] 9 => array:2 [ "identificador" => "sec0115" "titulo" => "Recommendation" ] 10 => array:2 [ "identificador" => "sec0120" "titulo" => "Proposed intervention" ] 11 => array:3 [ "identificador" => "sec0125" "titulo" => "Intraoperative period" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0130" "titulo" => "Anesthetic management" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0135" "titulo" => "What is the optimal anesthesia that manages to improve the immediate and short-term results after LT?" ] ] ] ] ] 12 => array:2 [ "identificador" => "sec0140" "titulo" => "Recommendations" ] 13 => array:3 [ "identificador" => "sec0145" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0150" "titulo" => "What is the optimal method of anesthetic monitoring that improves immediate and short-term results after LT?" ] ] ] 14 => array:2 [ "identificador" => "sec0155" "titulo" => "Recommendations" ] 15 => array:3 [ "identificador" => "sec0160" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0165" "titulo" => "How do intraoperative transfusion management, antifibrinolytic therapy, and coagulation monitoring influence immediate and short-term results after LT?" ] ] ] 16 => array:2 [ "identificador" => "sec0170" "titulo" => "Recommendations" ] 17 => array:3 [ "identificador" => "sec0175" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0180" "titulo" => "What is the role of early extubation in the immediate and short-term results after liver transplantation?" ] ] ] 18 => array:2 [ "identificador" => "sec0185" "titulo" => "Recommendations" ] 19 => array:3 [ "identificador" => "sec0190" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0195" "titulo" => "What is the role of perioperative analgesia in the immediate and short-term results after LT?" ] ] ] 20 => array:2 [ "identificador" => "sec0200" "titulo" => "Recommendations" ] 21 => array:3 [ "identificador" => "sec0205" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0210" "titulo" => "Surgical technique" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0215" "titulo" => "What type of surgical technique manages to improve immediate and short-term results after LT?" ] ] ] ] ] 22 => array:2 [ "identificador" => "sec0220" "titulo" => "Recommendations" ] 23 => array:3 [ "identificador" => "sec0225" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0230" "titulo" => "Do immediate and short-term results after LT improve with the placement of abdominal drain tubes, T-tube in the bile duct, NG tube, skin preparation or incision type?" ] ] ] 24 => array:2 [ "identificador" => "sec0235" "titulo" => "Recommendations" ] 25 => array:3 [ "identificador" => "sec0240" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0245" "titulo" => "What is the role of perfusion machines in improving the immediate and short-term results of the liver graft and recipient?" ] ] ] 26 => array:2 [ "identificador" => "sec0250" "titulo" => "Recommendations" ] 27 => array:2 [ "identificador" => "sec0255" "titulo" => "Proposed intervention" ] 28 => array:3 [ "identificador" => "sec0260" "titulo" => "Postoperative period" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0265" "titulo" => "Post-transplant nutrition" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0270" "titulo" => "Does early postoperative nutrition influence the recovery of patients undergoing LT?" ] ] ] ] ] 29 => array:2 [ "identificador" => "sec0275" "titulo" => "Recommended intervention" ] 30 => array:3 [ "identificador" => "sec0280" "titulo" => "Proposed intervention" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0285" "titulo" => "Postoperative rehabilitation" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0290" "titulo" => "How does early mobilization and respiratory rehabilitation influence the recovery of patients undergoing LT?" ] ] ] ] ] 31 => array:2 [ "identificador" => "sec0295" "titulo" => "Recommendation" ] 32 => array:3 [ "identificador" => "sec0300" "titulo" => "Proposed intervention" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0305" "titulo" => "Vascular monitoring and thromboprophylaxis management" ] 1 => array:3 [ "identificador" => "sec0310" "titulo" => "Immunosuppression management" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0315" "titulo" => "Which immunosuppressive strategy achieves better short-term results in patients undergoing LT?" ] ] ] ] ] 33 => array:2 [ "identificador" => "sec0320" "titulo" => "Recommendation" ] 34 => array:3 [ "identificador" => "sec0325" "titulo" => "Proposed interventions" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0330" "titulo" => "Antimicrobial prophylaxis" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0335" "titulo" => "What is the optimal antimicrobial prophylaxis to prevent postoperative infectious complications after liver transplantation?" ] ] ] ] ] 35 => array:2 [ "identificador" => "sec0340" "titulo" => "Recommendation" ] 36 => array:3 [ "identificador" => "sec0345" "titulo" => "Proposed interventions" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0350" "titulo" => "Post-transplant education" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0355" "titulo" => "Does post-transplant education influence the clinical evolution of patients undergoing LT?" ] ] ] ] ] 37 => array:2 [ "identificador" => "sec0360" "titulo" => "Recommendation" ] 38 => array:2 [ "identificador" => "sec0365" "titulo" => "Proposed interventions" ] ] ] 9 => array:2 [ "identificador" => "sec0370" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0375" "titulo" => "Authors' contribution" ] 11 => array:2 [ "identificador" => "sec0380" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0385" "titulo" => "Conflict of interests" ] 13 => array:2 [ "identificador" => "sec0390" "titulo" => "Acknowledgment" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-06-12" "fechaAceptado" => "2023-07-09" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1807629" "palabras" => array:5 [ 0 => "Liver transplantation" 1 => "Consensus" 2 => "Enhanced recovery after surgery" 3 => "Prehabilitation" 4 => "Discharge" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1807630" "palabras" => array:3 [ 0 => "LT" 1 => "SETH" 2 => "ERAS" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1807628" "palabras" => array:5 [ 0 => "Trasplante hepático" 1 => "Consenso" 2 => "Recuperación intensificada" 3 => "Prehabilitación" 4 => "Alta" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The goal of the Spanish Society for Liver Transplantation (<span class="elsevierStyleItalic">La Sociedad Española de Trasplante Hepático</span>) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses Enhanced Recovery After Liver Transplantation, dividing needed actions into three periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La Sociedad Española de Trasplante Hepático tiene como objetivo la promoción y elaboración de documentos de consenso sobre temas de actualidad en trasplante hepático de abordaje multidisciplinario. Para ello, en noviembre 2022 se celebró la X Reunión de consenso con participación de representantes de los 26 programas de trasplante hepático españoles autorizados. En esta edición se abordó la Recuperación Intensificada tras el Trasplante Hepático, dividiendo las acciones a realizar en tres periodos, preoperatorio, intraoperatorio y postoperatorio. Se expone a continuación las evidencias evaluadas, y las consecuentes recomendaciones consensuadas.</p></span>" ] ] "NotaPie" => array:3 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">El listado completo del panel de participantes representantes de los grupos nacionales de Trasplante Hepático se incluyen en la sección de agradecimientos.</p>" "identificador" => "fn0005" ] 1 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: L Lladó, Usera MA, Blasi A, Gutiérrez R, Montalvá E, Pascual S, et al. Documento de consenso de la Sociedad Española de Trasplante Hepático. Recuperación intensificada en trasplante hepático. Cir Esp. 2024;102:104–115.</p>" ] 2 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar9005">This article has been copublished with permission in <span class="elsevierStyleItalic">Gastroenterología y Hepatología</span> and <span class="elsevierStyleItalic">Cirugía Española</span>.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:3 [ "apendice" => "<p id="par0690" class="elsevierStylePara elsevierViewall">Félix Alegre (Clínica Universitaria de Navarra), Carolina Almohalla (H. U. Río Hortega), Pablo Bellot (H. Gral. U. de Alicante), Gerardo Blanco (H. U. Badajoz), Rubén Ciria (H. U. Reina Sofía), Gonzalo Crespo (H. U. Clínic i Provincial), Juan Echeverri (H. U. Marqués de Valdecilla), Carmen García Bernardo (H. U. Central de Asturias), Marta García Guix (H. U. de Bellvitge), Miguel Angel Gómez Bravo (H. U. Virgen del Rocío), Ernest Hidalgo (H. U. Vall d'Hebrón), Loreto Hierro (H. U. La Paz), Carmelo Loinaz (H. U. 12 de Octubre), Víctor López (H. U. Virgen de la Arrixaca), José Luis Lucena (H. U. Puerta de Hierro Majadahonda), José M. Morón (H. U. Son Espases), Javier Nuño (H. U. Ramón y Cajal), Elena Otón (H. U. Nuestra Sra. de la Candelaria), Pilar Palacios (H. Clínico U. Lozano Blesa), Mikel Prieto (H. U. de Cruces), Mario Romero (H. Gral. U. Gregorio Marañón), Julio Santoyo Villalba (H. Reg. U. de Málaga), Evaristo Varo (H. Clínico U. de Santiago), Maria Angeles Vázquez (H. U. A Coruña), Juan José Vila (H. U. La Fe Infantil), Trinidad Villegas (H. U. Virgen de la Nieves), Carmen Vinaixa (H. U. La Fe).</p>" "titulo" => "Annex: participants representing national groups" "identificador" => "sec0395" ] ] ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 1 \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">Waiting list \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Distribution of organs, MELD system, waiting list, waiting times \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Activities while on waiting list (nutrition, exercise, etc) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Obligatory abstinence from alcohol \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Tobacco cessation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Correlation between severity of the patient status before transplantation and mortality, so patient and family expectations after surgery should be realistic. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Possible withdrawal from the waiting list due to worsened conditions or improvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 2 \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">Relevant donor factors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Expanded donor criteria: older livers, hepatitis B (core), hepatitis C, fatty liver, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Possible use of liver segments: bipartition, living donor, reduced liver \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Possibility of donor not being valid and LT cancelled the same day \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 3 \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">Transplant surgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Standard evolution \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Surgery might be impossible to perform (due to intraoperative findings in the recipient or donor) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Risk of mortality \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 4 \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">Post-transplant complications \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Surgical: thrombosis of the hepatic artery, portal thrombosis, bile leak or stenosis, hemorrhage, graft dysfunction, primary liver failure, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Medical or psychological: wound infection, pneumonia, arrythmia, myocardial infarction, thrombosis, multiple organ failure, death, anxiety, post-traumatic stress, depression, feeling of guilt, etc. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Immunosuppression medication and secondary effects \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Evolution and standard management (ambulation, diet, etc) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">ICU/Hospital stay \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 5 \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">General \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Need for family support and compliance with treatment and appointments \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Possibility of early discharge whenever possible \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3508720.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Information checklist for when the patient is added to the waitlist.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Patient-related requirements</span></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Adequate pain control with oral analgesia</span></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Independent mobility (walking without assistance, dressing without assistance or with minimal help) and able to get to the corresponding hospital if symptoms of alarm appear</span></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Oral intake</span></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">No need for intravenous fluids</span></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">No uncontrolled medical or surgical complications</span></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Progressive improvement in lab results</span></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Plasma concentrations of immunosuppressants adapted for the patient’s target</span></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Post-transplant education regarding medication and lifestyle, including management of immunosuppression and glycemic control/administration of insulin, if necessary</span></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Stability or improvement of possible immunological complications</span></p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">No need for intervention or urgent imaging test at the time of discharge</span></p></li></ul> \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">Hospital-related requirements<span class="elsevierStyleBold"><span class="elsevierStyleItalic">Capability to cover the needs of the patient in a non-hospitalization regimen:</span></span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Home visits</span></p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Telephone consultations</span></p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Day hospital</span></p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Close follow-up in the office</span></p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">•</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Emergency room care</span></p></li></ul> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3508722.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Criteria for safe discharge.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ICU, intensive care unit; TP, total proteins.</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">Reference \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objective \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Result \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital stay \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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plank Hepatology 2015 \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">Randomized (n = 120) \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">Change in TP \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">Immunonutrition \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">Not achieved \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">9.5 vs 10 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LeCornu Transplantation 2000 \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">Randomized (n = 82) \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">Arm circumference/Grip strength \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">Nutritional supplements \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">Not achieved \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">No differences \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Aydogan Transplantation Proceedings 2013 \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">Retrospective observational (n = 153) \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">Influence of iron metabolism in post-LT \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">None \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">ICU stay 3 vs 5 days \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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Martucci Clinical Nutrition 2020 \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">Prospective observational (n = 64) \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">Influence of vit D levels in post-LT \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">None \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">ICU stay 3 vs 4 days \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">13.5 vs 19 days \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3508718.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Studies about the assessment and/or nutritional intervention before transplantation.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">PS, performance status.</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">Reference \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objective \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICU stay \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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Wallace Transplantation 2021 \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">Retrospective, observational, multicenter (n = 6968) \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">Influence of <span class="elsevierStyleBold">PS</span> on ICU/hospital stay \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">None \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">3.4 vs 5.9 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lai Am J Transplant 2018 \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">Prospective, observational, single-center (n = 214) \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">Correlation of the <span class="elsevierStyleBold">Liver Frailty Index</span> with post-LT \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">None \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">2 vs 3 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lai Hepatology 2021 \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">Prospective, observational, multicenter (n = 1166) \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">Correlation of the <span class="elsevierStyleBold">Liver Frailty Index</span> with post-LT \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">None \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">Frail: >% ICU > 4 d \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DeMaria Clin Transplantation 2019 \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">Observational, prospective, single-center (n = 50) \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">Correlation <span class="elsevierStyleBold">Fried Frailty Index</span> with post-LT \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">None \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">3 vs 3.5 d \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3508721.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Summary of fragility/PS studies.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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">Reference \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Study type \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Objective \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICU stay \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital stay \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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DiMartini Liver Transplant 2013 \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">Retrospective, observational, single-center (n = 338) \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">Influence <span class="elsevierStyleBold">SARCOPENIA</span> evolution post-LT \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">None \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">ICU stay predictor \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">Predictor hospital stay \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Esser Transplantation 2019 \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">Retrospective, observational, single-center (n = 186) \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">Influence <span class="elsevierStyleBold">SARCOPENIA</span> evolution post-LT \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">None \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">No clear correlation \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">No clear correlation (correlation with complications, graft failure and death) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Kalafateli Cachexia SM 2017 \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">Retrospective, observational, single-center (n = 232) \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">Influence <span class="elsevierStyleBold">SARCOPENIA</span> UCI/Hos stay \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">None \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">Correlation malnutrition stay >5 d \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">Correlation with stay >20 d mortality and infections \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Montazo-Loza Liver Transplant 2014 \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">Retrospective, observational, single-center (n = 248) \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">Influence <span class="elsevierStyleBold">SARCOPENIA</span> evolution post-LT \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">None \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"> \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">Longer stay, mortality and infections \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pinto Dos Santos Eur J GH 2020 \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">Retrospective, observational, single-center (n = 368) \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">Influence <span class="elsevierStyleBold">SARCOPENIA</span> evolution post-LT \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">None \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">25 vs 33 d \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"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3508723.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Summary of studies evaluating sarcopenia.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 1 \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">Standard follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Periodic office visits and follow-up studies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Telephone contact for consultations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Criteria for emergency department care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 2 \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">Immunosuppression \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Treatment at discharge \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Secondary effects \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Information compliance and analyses \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 3 \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">Nutrition and exercise \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Dietary recommendations \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Physical exercise \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Weight control \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block 4 \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">Other habits \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Skin care and avoiding sun exposure \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Abstinence from alcohol and tobacco \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \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">Information about pregnancy \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3508719.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Information checklist for post-transplant hospital discharge.</p>" ] ] 6 => array:5 [ "identificador" => "fig0005" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 488 "Ancho" => 1333 "Tamanyo" => 89557 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:57 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "CLINICAL PATHWAY Recovery Intensification for optimal Care in Adult’s surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Ramirez" 1 => "P. Ruiz-López" 2 => "A. Gurumeta" 3 => "A. Arroyo-Sebastian" 4 => "M. Bruna-Esteban" 5 => "A. Sanchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2022" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus statement on hemostatic management, anticoagulation, and antiplatelet therapy in liver transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Montalvá" 1 => "M. Rodríguez-Perálvarez" 2 => "A. Blasi" 3 => "S. Bonanad" 4 => "O. Gavín" 5 => "L. 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Special article
Consensus document from the Spanish Society for Liver Transplantation: enhanced recovery after liver transplantation
Documento de consenso de la Sociedad Española de Trasplante Hepático. Recuperación intensificada en trasplante hepático
Laura Lladóa,
, Manuel Abradelo de Userab, Annabel Blasic, Rosa Gutiérrezd, Eva Montalváe, Sonia Pascualf, Gonzalo Rodríguez-Laizg, en representación de la Sociedad Española de Trasplante Hepático (SETH) 1
Corresponding author
a Unidad de Cirugía HB y Trasplante Hepático, Servicio de Cirugía, Hospital Universitari Bellvitge, IDIBELL, Universidad de Barcelona, Barcelona, Spain
b Unidad de Cirugía HBP y Trasplante de Órganos, Servicio de Cirugía, Hospital Universitario 12 de Octubre, Imas12, Madrid, Spain
c Departamento de Anestesiología, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
d Servicio de Anestesiología-Reanimación, Hospital Universitario de Cruces, Bilbao, Spain
e Unidad de Cirugía HBP y Trasplante, Hospital Universitario y Politécnico La Fe, Universitat de València, CIBERehd, ISCIII, IIS LaFe, Valencia, Spain
f Unidad Hepática, Servicio de Digestivo, CIBERehd, ISABIAL, Hospital General Universitario Alicante, Alicante, Spain
g Unidad Hepática, Servicio de Cirugía, CIBERehd, ISABIAL, Hospital General Universitario Alicante, Alicante, Spain