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Introduction and aims: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making. Materials and methods: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed. Results: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4 ± 37.2 and 27.4 ± 28.7 months, respectively (p = 0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality. Conclusions: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making. Resumen: Introducción y objetivos: El carcinoma hepatocelular (CHC) es una neoplasia maligna primaria de células epiteliales hepáticas que constituye la neoplasia primaria hepática más frecuente. La ampliación de criterios de trasplante y resecabilidad han hecho más complejas las decisiones terapéuticas. Nos proponemos describir las características clínicas y supervivencia de los pacientes con CHC tratados mediante resección (RH) o trasplante hepático (THO) en nuestro Hospital, e identificar la presencia de factores que permitan predecir el pronóstico y facilitar las decisiones terapéuticas. Material y métodos: Se identificaron retrospectivamente los pacientes con CHC intervenidos con intención curativa en el Hospital Universitario Marqués de Valdecilla entre 2007 y 2017. Se analizaron la supervivencia, mortalidad, intervalo libre de enfermedad, así como distintas variables relacionadas con el pronóstico. Resultados: Se registraron 96 pacientes con un seguimiento medio tras cirugía de 44 meses. La mortalidad global y la recidiva fueron superiores en el grupo de resección. La supervivencia media fue de 51.4 meses en el grupo de TOH y de 37.5 meses en el de resección y el tiempo libre de enfermedad alcanzó los 49.4 ± 37.2 y 27.4 ± 28.7 meses, respectivamente (p: 0.002). La carga tumoral, valorada a través del “tumor burden score”, presentó una relación significativa con el riesgo de recidiva y la mortalidad específica. Conclusiones: No parece existir un subgrupo de pacientes en los que la resección quirúrgica presente resultados de supervivencia superiores o equiparables al trasplante. La carga tumoral podría ser una herramienta útil para subclasificar y ayudar a guiar las decisiones terapéuticas.

Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival. Resumen: La falla hepática aguda es un síndrome poco común pero grave, con una incidencia de aproximadamente 2000 a 3000 casos por año en América del Norte. Su fisiopatología y curso clínico varían según la causa del daño hepático primario, y puede llevar a una alta morbimortalidad o necesidad de trasplante hepático, a pesar de las terapias disponibles. Este síndrome involucra una activación excesiva del sistema inmunológico con daño en otros órganos, lo que contribuye a su alta tasa de mortalidad. La definición más aceptada incluye daño hepático con EH y coagulopatía en las últimas 26 semanas en un paciente sin enfermedad hepática previa. Las principales causas son intoxicación por paracetamol, hepatitis viral, lesión hepática inducida por drogas, entre otras. Es crucial identificar la causa, ya que influye en el pronóstico y tratamiento. La supervivencia ha mejorado con medidas de soporte, terapia intensiva, prevención de complicaciones y el uso de medicamentos como la N-acetilcisteína. El trasplante hepático es una opción curativa para casos no respondedores al tratamiento médico, pero la evaluación adecuada del momento para el trasplante es crucial para mejorar los resultados. Factores como la edad del paciente, la causa subyacente y la gravedad de las fallas orgánicas influyen en los resultados y la supervivencia post-trasplante.

OBJECTIVES: To determine the incidence of acute kidney injury during the first 7 days post-orthotopic liver transplantation and to identify factors associated with acute kidney injury. MATERIALS AND METHODS: A retrospective, single-center analysis was conducted from 2018 to 2023, including patients undergoing liver transplantation. Preoperative, intraoperative, and postoperative variables were analyzed. Variables were evaluated in three multivariate linear regression models. A p value < 0.05 was considered statistically significant. RESULTS: A total of 45 patients were included from which 19 manifested acute kidney injury according to KDIGO criteria. In the preoperative univariate analysis, BUN, urea, MELD-Na score, intraoperative hypotension, time at Intensive Care Unit, and intrahospital stay days (6 vs 9) were statistically significantly associated with acute kidney injury. In the multivariate analysis, only preoperative MELD-Na score, intraoperative hypotension, and time at Intensive Care Unit remained statistically significantly associated with the development of acute kidney injury after orthotopic liver transplantation. CONCLUSIONS: The incidence of acute kidney injury after orthotopic liver transplantation was lower than previously reported in Mexico and in international studies. Similarly, the main factors associated with acute kidney injury after orthotopic liver transplantation were preoperative MELD-Na score, intraoperative hypotension, and time at intensive therapy. [ABSTRACT FROM AUTHOR]

Introduction and aims: Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD). Methods: A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM. Results: A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60–10.7), p = 0.005) and 3.48 (95% CI 1.35–9.01, p = 0.010), when further controlled for pretransplant prediabetes. Conclusion: The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program. Resumen: Introducción y objetivos: La diabetes mellitus posterior a trasplante (DMPT) es una complicación grave de largo plazo que tiene un impacto negativo sobre el injerto y la sobrevida del paciente. El objetivo del presente estudio fue describir la incidencia de la DMPT en una cohorte mexicana y evaluar su asociación con el antecedente familiar de diabetes (AFD). Métodos: Se realizó un estudio de cohorte retrospectivo unicéntrico de pacientes sometidos a trasplante hepático (TH). El desenlace primario fue el tiempo entre el TH y el desarrollo de DMPT. El diagnóstico de DMPT fue establecido utilizando los criterios de la ADA. Se realizó un análisis de mediación que utilizó modelos de regresión de Cox ajustados y se manejó la prediabetes pretrasplante como mediador, para determinar el efecto total y el efecto directo del AFD sobre la DMPT. Resultados: Se incluyó a un total de 152 pacientes, con una mediana de seguimiento de 41 meses; 19.2% (n = 29) presentaron diabetes pretrasplante. Durante el tiempo de seguimiento, 15% de los pacientes desarrollaron DMPT (n = 23), con una tasa de incidencia de 4.71 casos/100 personas-año. La DMPT fue significativamente más elevada en pacientes con AFD en comparación con aquellos sin AFD (8.72 casos/100 personas-año vs 2.04 casos/100 personas-año, respectivamente; p = 0.001). El cociente de riesgo ajustado para el desarrollo de DMPT en los pacientes con AFD fue 4.14 (IC 95% 1.60–10.7; p = 0.005) y 3.49 (IC 95% 1.35–9.01; p = 0.010), cuando se controló por prediabetes pretrasplante. Conclusión: La incidencia de DMPT fue similar a la reportada en la mayoría de los estudios internacionales. Al igual que con la diabetes tipo 2, el AFD juega un papel importante en el desarrollo de la DMPT, incluso después de considerar la prediabetes pretrasplante. Los pacientes con AFD deben someterse a un programa metabólico más estricto.

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El tratamiento de la enfermedad hepática terminal con Cardiomiopatía Cirrótica (CMC) es el trasplante hepático (TH), sin embargo el tratamiento médico con la combinación de diuréticos y beta bloqueantes no selectivos antes y después tienen un rol importante. A diferencia de la insuficiencia cardíaca de otras etiologías, los inhibidores de la enzima convertidora (IECA), los bloqueadores del receptor de angiotensina 2 (ARA-2) o los inhibidores del receptor de angiotensina y de neprilisina (ARNI) no se recomiendan debido a la fisiopatología particular de la CMC. El shunt porto-sistémico intrahepático transyugular (Transjugular intrahepatic porto-systemic shunt: TIPS) tiene sus indicaciones con posibles beneficios y riesgos pero más estudios son necesarios en la CMC. El TH es la opción más eficaz y puede revertir el QTc del ECG y la disfunción diastólica y sistólica; en las últimas décadas, a pesar del aumento de la complejidad en los pacientes (mayor score MELD), con la mejoría de la técnica quirúrgica, cuidados intensivos, drogas inmunosupresoras y diagnóstico por imágenes la sobrevida ha mejorado significativamente.

Introduction and aims: Orthotopic liver transplant (OLT) is the definitive treatment of most types of liver failure. Transjugular intrahepatic portosystemic shunt (TIPS) and portocaval shunt placement procedures reduce the systemic vascular complications of portal hypertension. TIPS placement remains a “bridge” therapy that enables treatment of refractory symptoms until transplantation becomes available. The aim of the present study was to describe the operative impact of TIPS prior to OLT. Materials and methods: A retrospective review was conducted on patients that underwent liver transplant at the Hospital San José within the timeframe of 1999 and February 2020. Results: We reviewed a total of 92 patients with OLT. Sixty-six patients were male and 26 were female, with a mean age of 52 years. Nine (9.8%) of the 92 patients had a TIPS, before the OLT. Preoperative Child-Pugh class, MELD score, and sodium and platelet levels were similar between groups. We found no difference in the means of intensive care unit stay, operative time, or blood transfusions for liver transplant, with or without previous TIPS. There was no significant difference between groups regarding vascular and biliary complication rates or the need for early intervention. The overall one-year mortality rate in the TIPS group was 11%. Conclusions: TIPS is an appropriate therapeutic bridge towards liver transplant. We found no greater operative or postoperative complications in patients with TIPS before OLT, when compared with OLT patients without TIPS. The need for transfusion, operative time, and ICU stay were similar in both groups. Resumen: Introducción y objetivos: El trasplante de hígado ortotópico (OLT, por sus iniciales en inglés) es el tratamiento definitivo para la mayoría de los tipos de falla hepática. Procedimientos tales como la derivación portosistémica intrahepática transyugular (TIPS, por sus iniciales en inglés) y la derivación portocava, reducen las complicaciones vasculares sistémicas de la hipertensión portal. El procedimiento de TIPS permanece como una terapia de “puente”, para permitir el tratamiento de síntomas refractarios hasta que el trasplante esté disponible. Este estudio busca describir el impacto operatorio de una TIPS previo a un OLT. Material y métodos: Se realizó una revisión retrospectiva en pacientes que fueron sometidos a trasplante hepático en el Hospital San José, de 1999 hasta febrero del 2020. Resultados: Se incluyeron 92 pacientes con OLT. Sesenta y seis fueron masculinos y 26 femeninos, con una edad promedio de 52 años. Nueve de los 92 pacientes (9.8%) tuvieron una TIPS previo al OLT. Los valores de clase Child, MELD, sodio en sangre y plaquetas fueron similares en el preoperatorio de ambos grupos. No encontramos diferencia en las medias de estancia en la unidad de cuidados intensivos (UCI), tiempo operatorio y transfusiones de sangre para OLT, con o sin TIPS previa. Las tasas de complicaciones vasculares y biliares, así como la necesidad de una intervención temprana, no fueron significativamente diferentes entre los grupos. La mortalidad general en un año en el grupo TIPS fue del 11%. Conclusiones: La TIPS es un puente terapéutico apropiado para el trasplante de hígado. No encontramos mayores complicaciones operatorias o postoperatorias en los pacientes con TIPS antes del OLT, en comparación con los pacientes con OLT sin TIPS. La necesidad de transfusión, el tiempo operatorio y la estancia en la UCI fueron similares en ambos grupos.

El estudio diagnóstico no invasivo del riesgo cardiovascular en pacientes que van a ser llevados a trasplante hepático no es claro especialmente en asintomáticos. Respecto a la gammagrafía de perfusión miocárdica (GPM) se ha pensado que la reserva vasodilatadora deteriorada en estos pacientes puede reducir su rendimiento. El objetivo es valorar el papel de la GPM en la evaluación prequirúrgica de los pacientes que van a ser tratados mediante un trasplante hepático. Estudio retrospectivo, descriptivo y observacional. Se incluyó a todos los pacientes adultos llevados a trasplante hepático entre 2017 y 2021 que tuvieran GPM previa. Se describen los hallazgos de la GPM y se correlacionaron con los hallazgos de angiografía invasiva y con la aparición o no de eventos cardiovasculares peri y postrasplante. De 188 pacientes trasplantados (edad promedio: 57 años, DE: 12), 178 tenían perfusión miocárdica previa, 82 (46%) pacientes no tenían factores de riesgo cardiovascular y 5 (2,8%) tenían antecedente de enfermedad coronaria. De las GPM, 177 fueron con estrés con dipiridamol realizadas en promedio 10 meses antes del trasplante. Únicamente 17/178 (9,5%) estudios fueron anormales. El seguimiento medio fue de 38 meses (DE: 10). De los pacientes con GPM normal, solo 2 (1,2%) presentaron eventos cardiovasculares, ambos con estudios realizados más de 2 años atrás. No hubo muertes de origen cardiovascular. La GPM es una técnica segura y confiable en la valoración cardiovascular en pacientes candidatos a trasplante hepático dada la baja tasa de falsos negativos en el seguimiento. The non-invasive diagnostic study of cardiovascular risk in patients who are going to undergo liver transplantation is not clear, especially in asymptomatic patients. Regarding myocardial perfusion scintigraphy (MPS), it has been thought that the impaired vasodilator reserve in these patients may reduce its performance. The objective is to assess the role of the MPS in the pre-surgical evaluation of patients who are going to undergo liver transplantation. Retrospective, descriptive and observational study was designed. All adult patients undergoing liver transplantation between 2017 and 2021 who had previous MPS were included. The findings of MPS were described and correlated with the findings of invasive angiography and with the appearance or not of peri- and post-transplant cardiovascular events. There were a total of 188 transplanted patients (mean age: 57 years, SD: 12), 178 had previous myocardial perfusion, 82 (46%) patients had no cardiovascular risk factors, and 5 (2.8%) had a history of coronary disease. Of the MPS, 177 were with dipyridamole stress performed on average 10 months before transplantation. Only 17/178 (9.5%) studies were abnormal. The mean follow-up was 38 months (SD: 10). Of the patients with normal MPS, only 2 (1.2%) presented cardiovascular events, both with studies performed more than 2 years before the procedure. There were no deaths of cardiovascular origin. MPS is a safe and reliable technique for cardiovascular assessment of patients who are candidates for liver transplantation, given the low rate of false negatives during follow-up. [ABSTRACT FROM AUTHOR]

Hepatitis C virus (HCV) infection is a worldwide public health problem associated with significant morbidity and mortality. In the context of liver transplantation, the demand for organs continues to exceed the supply, prompting the consideration of using organs from HCV-positive donors in HCV-negative recipients. The introduction of direct-acting antivirals (DAAs), which have demonstrated great efficacy in eradicating the virus, has made transplantation of organs from donors with HCV infection possible. The present article provides a brief review of the current evidence on the use of organs from HCV-infected patients. Resumen: La infección por el virus de hepatitis C (VHC) es un problema de salud pública a nivel mundial asociado a una gran morbilidad y mortalidad. En el caso del trasplante hepático, la demanda de órganos continúa siendo mayor que la oferta. Este problema ha llevado a tomar en consideración el uso de órganos de donadores con VHC positivos en receptores negativos.Gracias al advenimiento de los antivirales de acción directa (AAD), los cuales han mostrado ser altamente efectivos para la curación del virus, ha sido posible procurar y utilizar órganos de donadores con infección por VHC para ser trasplantados. En este artículo se hace una breve revisión de la evidencia actual del uso de órganos provenientes de pacientes infectados por VHC.

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Se revisaron las historias clínicas de todos los pacientes con trasplante hepático atendidos en el Centro Especializado San Vicente Fundación entre enero de 2013 y junio de 2017, para determinar la frecuencia de síndrome metabólico (SM) postrasplante. En instrumento validado se registraron datos sociodemográficos, antecedentes patológicos, antecedentes toxicológicos, complicaciones y criterios ATP III. Se utilizó OpenEpi 3,01 para análisis estadístico; se consideró significancia estadística con p

Background. Intestinal perforation (IP) after pediatric liver transplant (PLT) is an uncommon complication with high mortality reported. The aim of this study is to identify the risk factors and management of this complication. Material and methods. Retrospective study of IP after PLT from January 2014 to October 2020. Results. Four intestinal perforations were indentificated in 102 PLT (3,9%). Three patients with BA and one neonate with hemo-chromatosis (HC) presented this complication. The mean weight of patients with IP was 6.3± 2.5kg (3.1-9) and 19.9 ± 15.4kg for the rest (p< 0,05). All IP with BA had a previous laparotomy. Two living donors and two left lateral reduced liver were implanted. The diagnosis of intestinal perforation was done on day 11 ± 3.3 (8-15 days). Diagnosis was suspected with clinical and biological signs of perforation, CT scan confirmed the diagnosis in patiens with BA and by direct visualization through the mesh for temporary closure in the patient with hemocromatosis. Urgent laparotomy was performed. We identified three colonic perforations, all of them in BA patients and all repaired with direct suture. The patient with HC presented multiple perforations secondary to necrotizing enterocolitis requiring an ileostomy and finally died due to multiorgan failure. Conclusion. Intestinal perforation after PLT is an infrequent complication. Age, weight, previous laparotomy and BA could be risk factors for IP in PLT. Urgent laparotomy after diagnosis should be performed in order to reduce mortality. Isolated IP with adequate treatment might not affect long term outcomes after pediatric liver transplantation. Key Words: Intestinal perforation; Liver transplantation; Pediatric liver transplant [ABSTRACT FROM AUTHOR]

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Introduction: Liver transplantation is the only curative treatment for patients with end-stage liver disease. Neurological complications are one of the main causes of morbidity and mortality. Objective: To study neurological complications after liver transplantation in paediatric patients. Methods: We conducted a retrospective study, including all paediatric patients younger than 17 years undergoing liver transplantation over a 12-year period at our centre. Results: Forty-six liver transplantations were performed in 38 patients. The most common indication was biliary atresia. Up to one-third of patients presented neurological complications, with psychomotor agitation being the most frequent. Incidence of neurological complications was significantly higher in the group of infants than in older age groups. Encephalopathy was more common in patients with acute liver failure than in those with chronic liver failure. Conclusions: Neurological complications, and particularly psychomotor agitation, are common after liver transplantation in paediatric patients. Resumen: Introducción: El trasplante hepático (TH) es el único tratamiento curativo para enfermos en situación de fallo hepático terminal. Las complicaciones eurológicas (CN) son una causa importante de morbimortalidad. Objetivos: Estudiar la incidencia de CN en pacientes pediátricos sometidos a un TH. Pacientes y métodos: Estudio retrospectivo en el que se incluyeron todos los pacientes menores de 17 años sometidos a TH durante un periodo de 12 años. Resultados: Se realizaron 46 TH en 38 pacientes. La indicación más frecuente fue la atresia de vías biliares. En un tercio de los pacientes hubo alguna CN, siendo la más frecuente la agitación psicomotora. Se encontró una menor incidencia de CN en el grupo de lactantes con respecto a los pacientes de mayor edad, de forma estadísticamente significativa. El desarrollo de encefalopatía en casos de fallo hepático agudo fue más frecuente que en aquellos con insuficiencia hepática crónica. Conclusiones: Las CN en los niños son frecuentes después de un TH, siendo la más frecuente la agitación psicomotora.

Background and rationale: Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear. Material and methods: We carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009–December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups: no CKD (eGFR, ≥60 mL/min/1.73 m2), mild CKD (eGFR, 30–59 mL/min/1.73 m2), severe CKD (eGFR, 15–29 mL/min/1.73 m2), and end-stage renal disease (ESRD). Results: We enrolled 410 patients followed for 53.2 ± 32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P = 0.044), raised levels of serum uric acid (P 60 ml/min/1,73 m2), ERC leve (FGe: 30-59 ml/min/1,73 m2), ERC grave (FGe: 15-29 ml/min/1,73 m2) y enfermedad renal terminal (ERT). Resultados: Incluimos a 410 pacientes a los que se hizo un seguimiento durante 53,2 ± 32,6 meses: 39 tenían ERC al inicio y 95 desarrollaron ERC de novo durante el periodo de observación. Había 184 (44,9%) receptores con anticuerpos contra el VHC, 47 (11,5%) con positividad para el HBsAg y 33 (8,1%) portadores del virus de la hepatitis B (VHB) o el virus de la hepatitis D (VHD). Los factores de riesgo de los receptores para presentar ERC al inicio fueron la edad avanzada (p = 0,044), unos niveles elevados de ácido úrico en suero (p

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Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute kidney injury is a frequent complication in patients with advanced liver cirrhosis. About 20-50% of patients hospitalized for decompensation of cirrhosis have kidney injury on admission or evolution during hospitalization. The differential diagnosis among the different causes of acute kidney injury is essential and the treatment differs completely among each one. A better prognosis has been observed in patients with parenchymal nephropathy and a poorer prognosis in acute kidney injury-related infections and hepatorenal syndrome. Finally, there are consistent data showing that some urine biomarkers, particularly NGAL (neutrophil gelatinase-associated lipocalin) can be useful in clinical practice for differential diagnosis. Patients with acute kidney injury have a poor short-term prognosis, especially patients with hepatorenal syndrome, so these patients should be selected for liver transplantation, therefore eligible candidates should be identified early and referred for liver transplantation evaluation. [ABSTRACT FROM AUTHOR]

Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase. Resumen: El trasplante hepático es un tratamiento que salva vidas, mejora la supervivencia y la calidad de vida. El procedimiento requiere de una adecuada selección de los receptores, llevada a cabo por un equipo multidisciplinario. La evaluación psicosocial es necesaria para la selección de los receptores y tiene como objetivos principales la identificación de problemas y necesidades psicosociales del paciente y su familia para mejorar los resultados del trasplante. Diferentes condiciones psicosociales son consideradas factores de riesgo para morbilidad y mortalidad posterior al trasplante. La presencia de estos factores por si solos no es considerada contraindicación absoluta, por lo que una adecuada evaluación, promueve la equidad en el acceso a la salud, mejora los resultados y optimiza los recursos. Esta revisión proporciona una visión general y una guía de los aspectos psicosociales más importantes durante la fase pre-trasplante.

We make a summary of the global and local cases, as well as the current etiological progress, constructive criticism is verified in order to improve the diagnostic process and limit the morbidity and mortality of patients, as well as the requirements of special therapies such as artificial liver support therapy or hepatic transplantation, not very affordable in our country. [ABSTRACT FROM AUTHOR]

Living donor liver transplantation is a complex and challenging procedure. The surgeon needs to guarantee maximum safety for the donor, as well as the best quality of the graft for the recipient. For this reason, the implementation of mini-invasive surgery has been slow in this area. However, in the last 10 years, due to the advances in laparoscopic liver surgery, the interest of some highly specialized groups has increased in incorporating mini-invasive surgery into donor surgery, mainly in pediatric living donor liver transplantation. The favorable results obtained in this field, have even led to turn this procedure, into the technique of choice for pediatric living donor liver transplantation. Nevertheless, this procedure is even more challenging for adult-to-adult living donor transplantation. To meet the volumetric criteria of an adult, a complete hepatectomy of right or left lobe is mostly required. This surgery is of greater complexity and risk for the donor, so its indication by minimally invasive approach is limited to high-volume centers with preparation, both in laparoscopy and liver transplants. In this report we seek to present our surgical technique and initial experience with the first pure laparoscopic right hepatectomy for adult-to-adult living donor liver transplantation carried out in Chile. [ABSTRACT FROM AUTHOR]

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The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 affected close to 2 million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy. Resumen: La enfermedad por coronavirus 2019 (COVID-19) es causada por el virus de Síndrome Respiratorio Agudo Grave - Coronavirus 2 (SARS-CoV-2). COVID 19 afectó cerca de 2 millones de personas en todo el mundo en menos de 4 meses posterior al reporte de los primeros casos en China en diciembre 2019. La relación que guarda la enfermedad por SARS-Cov-2 con el tratamiento inmunosupresor utilizado en diversos trastornos gastrointestinales es incierta, esto genera el debate sobre suspender el tratamiento inmunosupresor para mejorar el pronóstico de la infección, lo cual incluye el riesgo inherente de rechazo de injerto o agudización de enfermedades autoinmunes que potencialmente pudieran agravar el curso de la infección. En base a la evidencia disponible se logra establecer una postura de tratamiento en pacientes con enfermedades gastrointestinales que requieren terapia inmunosupresora.

Introduction and Aims: Hepatocellular carcinoma (HCC) is a primary malignant tumor of liver epithelial cells and is the most frequent primary liver cancer. The broadening of transplantation and resectability criteria has made therapeutic decisions more complex. Our aim was to describe the clinical and survival characteristics of patients with HCC treated through resection or liver transplantation at our hospital and identify the presence of factors that enable outcome prediction and facilitate therapeutic decision-making., Materials and Methods: Patients with HCC that underwent surgery with curative intent at the Hospital Universitario Marqués de Valdecilla, within the time frame of 2007 and 2017, were retrospectively identified. Survival, mortality, disease-free interval, and different outcome-related variables were analyzed., Results: Ninety-six patients with a mean follow-up after surgery of 44 months were included. Overall mortality and recurrence were higher in the resection group. Mean survival was 51.4 months in the liver transplantation group and 37.5 months in the resection group, and the disease-free interval was 49.4 ± 37.2 and 27.4 ± 28.7 months, respectively (p = 0.002). The tumor burden score was statistically significant regarding risk for recurrence and specific mortality., Conclusions: There appears to be no patient subgroup in whom the results of surgical resection were superior or comparable to those of transplantation. Tumor burden determination could be a useful tool for patient subclassification and help guide therapeutic decision-making., (Copyright © 2023 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Acute liver failure is a rare but serious syndrome, with an incidence of approximately 2,000 to 3,000 cases per year in North America. Its pathophysiology and clinical course vary, depending on the cause of the primary liver injury, and can lead to high morbidity and mortality or the need for liver transplantation, despite available therapies. This syndrome involves excessive activation of the immune system, with damage in other organs, contributing to its high mortality rate. The most accepted definition includes liver injury with hepatic encephalopathy and coagulopathy within the past 26 weeks in a patient with no previous liver disease. The main causes are paracetamol poisoning, viral hepatitis, and drug-induced liver injury, among others. Identifying the cause is crucial, given that it influences prognosis and treatment. Survival has improved with supportive measures, intensive therapy, complication prevention, and the use of medications, such as N-acetylcysteine. Liver transplantation is a curative option for nonresponders to medical treatment, but adequate evaluation of transplantation timing is vital for improving results. Factors such as patient age, underlying cause, and severity of organ failure influence the post-transplant outcomes and survival., (Copyright © 2024 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

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Objetivo: Nuestro estudio tiene como objetivo principal valorar la evolución de los niveles de esclerostina en pacientes con trasplante hepático, e investigar su relación con otros marcadores de remodelado óseo. Material y método: Estudio observacional prospectivo. Se incluyeron 83 pacientes con trasplante hepático. Se determinaron los valores de esclerostina, β-crosslaps, fosfatasa alcalina ósea, osteocalcina y proteína C reactiva la semana anterior al trasplante y posteriormente, a los 1, 3, 6 y 12 meses. Se determinaron basalmente la 25 hidroxi-vitamina D y la paratohormona. En cada revisión se evaluó la existencia de fracturas. La evolución de los marcadores respecto del valor basal se determinó mediante la prueba t-Student. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. Resultados: 56 varones y 27 mujeres (edad media: 56,2±10,4 años). Los niveles basales de esclerostina (0,76±0,35 ng/ml) disminuyeron de forma significativa precozmente (0,55±0,22 ng/ml en el primer mes, p=0,034), tendencia que se mantuvo hasta los 12 meses (0,62±0,22 ng/ml, p=0,047). Al contrario, los niveles basales de osteocalcina (17±10,3 ng/ml) y β-crosslaps (0,44±0,3 ng/ml) se incrementaron significativamente a los largo del estudio; en el caso de la osteocalcina, hasta los 12 meses (37,27±26,84 ng/ml, p

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The development of machine learning (ML) tools in many different medical settings is largely increasing. However, the use of the resulting algorithms in daily medical practice is still an unsolved challenge. We propose an epistemological approach (i.e., based on logical principles) to the application of computational tools in clinical practice. We rely on the classification of scientific inference into deductive, inductive, and abductive comparing the characteristics of ML tools with those derived from evidence-based medicine [EBM] and experience-based medicine, as paradigms of well-known methods for generation of knowledge. While we illustrate our arguments using liver transplantation as an example, this approach can be applied to other aspects of the specialty. Regarding EBM, it generates general knowledge that clinicians apply deductively, but the certainty of its conclusions is not guaranteed. In contrast, automatic algorithms primarily rely on inductive reasoning. Their design enables the integration of vast datasets and mitigates the emotional biases inherent in human induction. However, its poor capacity for abductive inference (a logical mechanism inherent to human clinical experience) constrains its performance in clinical settings characterized by uncertainty, where data are heterogeneous, results are highly influenced by context, or where prognostic factors can change rapidly., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

Introduction: Because of the obesity epidemic, more obese patients are on liver transplant (LT) waiting lists. The diseases associated with obesity may increase complications and limit survival after LT. However, there is no established measure or cut-off point to determine this impact and aid decision making. The aim of the present study is to evaluate obesity in patients undergoing LT via BMI and CT-based measurement of adipose tissue (AAT). These parameters will be used to predict the risk of postoperative complications and 5-year survival., Methods: A retrospective, single-center study was carried out at a tertiary Spanish hospital, including all patients who received LT between January 2012 and July 2019 (n = 164). The patients were adults who underwent LT using the 'piggyback' technique, preserving the recipient vena cava. Visceral adipose tissue (VAT) and BMI were calculated to examine correlations with postoperative complications and 5-year survival., Results: No significant association was found between postoperative complications by Comprehensive Complication Index, BMI, AAT/height, subcutaneous fat/height and VAT/height. Kaplan-Meier curves for 5-year survival compared LT recipients with BMI < 30.45 versus ≥30.45, with an estimated survival of 58.97 months versus 43.11 months, respectively (P < .001) (Fig. 3) and for LT recipients with an AAT/height <27.35 mm versus ≥27.35 mm, with an estimated survival of 57.69 months versus 46.34 months (P = .001)., Conclusions: This study does not show a higher rate of postoperative complications in obese patients. There is a significantly lower long-term survival in patients with AAT/height ≥27.35 mm and BMI ≥ 30.45. BMI is a valid estimate of obesity and is predictive of survival., (Copyright © 2024. Published by Elsevier España, S.L.U.)

The term portosinusoidal vascular disorder (PSVD) refers to a clinical-pathological entity that encompasses those patients with intrahepatic vascular damage without cirrhosis at risk of developing severe complications of portal hypertension. Numerous systemic diseases, genetic disorders, and toxic agents have been associated with this pathology, making its diagnosis an important clinical challenge. The recent description of uniform diagnostic criteria and a better understanding of its pathophysiology will allow for better identification of patients, even in early stages of the disease. Although there is currently no effective etiological treatment available, early diagnosis allows for the development of preventive strategies for some severe complications of portal hypertension., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Introduction and Aims: Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD)., Methods: A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM., Results: A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes., Conclusion: The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program., (Copyright © 2023 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

RESUMEN Introducción: la infección por virus hepatitis C (VHC) ha sido causa de importante morbi-mortalidad en hemofilia, planteándose el trasplante hepático (TH) por cirrosis y/o carcinoma hepatocelular (CHC). Caso clínico: presentamos los casos con coagulopatías congénitas e infección por VHC sometidos a TH en nuestro centro: tres pacientes con hemofilia A y uno con enfermedad de von Willebrand (EvW) tipo 3. Evaluamos el curso de la coagulopatía, el manejo perioperatorio, el consumo de factor y componentes sanguíneos y la supervivencia postrasplante. El factor deficitario se comenzó a administrar en bolo iv directo una hora antes del inicio de la cirugía para alcanzar un nivel deseado de dicho factor de 100 UI/dl, mantenido hasta conseguir el control estable de la hemostasia. Los tres pacientes con hemofilia A curaron su coagulopatía postrasplante. El factor VIII (FVIII) fue 93 UI/dl a los once años, 59 UI/dl a los 13 meses y 109 UI/dl a los nueve meses postrasplante en cada uno de los casos. El consumo medio perioperatorio de concentrados de FVIII fue 175 UI/kg, infundido hasta 36 h postrasplante de media. El paciente con EvW tipo 3 consiguió atenuar el curso natural de su sintomatología hemorrágica sin que se detectaran niveles hemostáticos del antígeno del factor von Willebrand (FVW:Ag) postrasplante. Discusión: tras el trasplante hepático, se produce la curación de la hemofilia A y la mejoría del fenotipo hemorrágico en la EvW tipo 3.

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Introduction: Acute liver failure (ALF) is a rapidly progressive and multisystem syndrome with high mortality. Objective: To determine prognostic factors of poor outcome in children with ALF. Material and methods: This is a retrospective cohort study with children under 14 years of age. In order to compare clinical and laboratory factors, patients were grouped according to their prognosis, favorable (recovery) and unfavorable (death or need for liver transplantation [LT]). Cox proportional risk analysis was used to determine the association of factors associated with prognosis. Results: 44 patients were included. In the majority, the etiology of ALF could not be identified (56.8%). Fifteen patients (34.1%) had a favorable evolution, and 29 (65.9%) had a poor evolution: 15 died and 14 met LT criteria. In the multivariate model, the poor prognostic factors were: INR (international normalized ratio) > 3.5 (HR = 2.235; 95% CI: 1.722-6.914; p = 0.043) and a higher LIU score (Liver Injury Unit scoring system) (HR = 2.0; 95% CI: 1.996-2.005; p = 0.049). Conclusions: Mortality in children with ALF is high. Factors associated with an unfavorable evolution were INR > 3.5 or high LIU scores. [ABSTRACT FROM AUTHOR]

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Organ donation in Chile is insufficient, with a historical rate of six donors per million inhabitants. Legal reforms, organizational improvements, and communications campaigns have made 2019 the most successful year in terms of organ donations and transplants. The first liver transplant in Chile was performed in 1969 at the Naval Hospital in Valparaíso. However, the patient passed away shortly after. The first successful transplant was performed in 1985 at the Militar Hospital in Santiago. As of that date to present day, 1.812 liver transplants have been performed: 43.6% of these in university hospitals, 35.1% in private clinics, and 21.5% in state hospitals. Of these, 23.1% were performed at the Pontificia Universidad Católica de Chile (PUC), 20.6% at the Universidad de Chile Clinical Hospital (HCUCH), 15.9% at the Luis Calvo Mackenna Hospital (HLCM), 15.9% at the Las Condes Clinic (CLC), 14.3% at the Alemana Clinic in Santiago (CA), 5.6% at the del Salvador Hospital (HdS), 2% at the Dávila Clinic (CD), 2% at the Alemán Sanatorium in Concepción (SA), and 0.9% at the Santa María Clinic (CSM). Of this total, 455 correspond to pediatric patients. Of these patients, 63.3% were at the Luis Calvo Mackenna Hospital, 21.1% at the Las Condes Clinic, 7.7% at the Pontificia Universidad Católica de Chile, 6.4% at the Alemana Clinic, and 1.5% at the Alemán Sanatorium. Since 2015, approximately 80% of pediatric transplants are performed at the HLCM. Reported one-year survival range from 75% to 85% in adults and 75% to 92% in pediatric patients per year, depending on the period. Some centers have never reported their results. It is expected that education of a society prone to organ donation improves, as well as improving the detection, maintenance, and procurement of potential donors, increasing the utilization of organs, enhancing the utilization of organs from deceased donors with Split technique, and, while we are building towards a donation system that responds to the needs of the nation, upholding live donor programs. Finally, younger generations are to be motivated so that they dedicate themselves to this important activity. [ABSTRACT FROM AUTHOR]

Background: Choosing the method of nutritional assessment is essential for proper follow-up of the nutritional status of patients undergoing liver transplantation. Objectives: Evaluate and compare the nutritional status of cirrhotic patients before and after liver transplantation over a year by different methods of nutritional assessment. Methods: Patients undergoing liver transplantation were assessed in five phases: pre-transplant, 1, 3, 6 and 12 months after transplantation at the hospital Santa Casa de Misericordia de Porto Alegre, RS, Brazil. The methods used for nutritional assessment were anthropometry, grip strength of the non-dominant hand (HGS) by dynamometry, thickness of the adductor pollicis muscle (APM) and phase angle (PA) by bioelectrical impedance analysis (BIA). In all evaluations, the same measurements were taken. Results: Evaluations were performed in 22 patients. Methods that showed a higher prevalence of malnourished patients before transplantation were PA by BIA (25%), arm muscle circumference (AMC) (21.9%) and arm circumference (AC) (18.8%). When comparing the nutritional status of patients during follow-up, there was a significant difference only in the evaluation methods AC, triceps skinfold thickness and PA by BIA. At the end, the methods of nutritional assessment were compared again. They showed a significant statistical difference, with HGS being the best method for detecting malnutrition. Conclusions: In conclusion, it is suggested that the method PA by BIA could be widely used with this population since the results are consistent with other findings in the literature and they are significant, reliable, and reproducible. [ABSTRACT FROM AUTHOR]

Introduction: Orthotopic liver transplantation (OLT) is a procedure characterized by high bleeding rates and a significant likelihood of exposure to blood products. Objectives: This case series shows the experience at a referral center for Jehovah's Witnesses (JW) with end-stage liver disease, undergoing OLT. Materials and methods: A search was conducted in our database of JW undergoing OLT between July 2007 and August 2012. The information about their pre-operative condition and progress up to 30 days posttransplantation. Results: Four subjects were identified (3F/1M) with an average age of 42 years (range 22-55). All of them received a multidisciplinary management which included pre-operative optimization of red cell mass, antifibrinolytic prophylaxis, and cell salvage (mean volume of 344mL [range 113-520]). The average intraoperative bleeding volume was of 625mL (range 300-1000). One of the patients presented with a primary graft dysfunction and died, while the rest had a normal postoperative course. Conclusion: It is possible to offer OLT to patients who refuse to receive allogeneic blood transfusions, through a comprehensive approach that includes perioperative hematologic optimization and the use of blood conservation measures, without a significant impact on the outcomes. [ABSTRACT FROM AUTHOR]

RESUMEN La neoplasia papilar intraductal (NPI) o papilomatosis biliar (PB) es una enfermedad recurrente con un alto riesgo de transformación maligna. Cuando la enfermedad afecta de forma difusa a la vía biliar (VB), el trasplante hepático (TH) es la única alternativa terapéutica disponible. Presentamos el caso de un varón de 43 años que debutó con un cuadro de colangitis aguda, siendo diagnosticado de papilomatosis biliopancreática difusa. El paciente fue sometido a una pancreatectomía total en dos tiempos y finalmente, a un TH, descartándose la presencia de focos de carcinoma infiltrante o de afectación ganglionar tanto en el páncreas inicialmente como en el hígado a posteriori. A los dos años de seguimiento, el paciente desarrolló una recidiva hepática multicéntrica cuya biopsia fue compatible con adenocarcinoma de origen biliar. En 2010, Vibert y cols. describieron que en los casos de PB sin presencia de carcinoma infiltrante o afectación ganglionar, el TH era una opción de tratamiento eficaz. Este caso es el primero que describe recidiva de la enfermedad después del TH en ausencia de focos de carcinoma infiltrante y de afectación ganglionar. Cuando la papilomatosis afecta de forma extensa a la VB, es posible que durante el análisis histopatológico pequeños focos de microinfiltración puedan no ser detectados. No obstante, aunque se trata de una enfermedad recidivante, la patogenia es desconocida, y no sabemos si la papilomatosis podría recidivar sobre el injerto después del TH incluso en ausencia de carcinoma infiltrante.

El objetivo principal del trasplante hepático es mejorar la supervivencia y la calidad de vida de los pacientes con enfermedades graves del hígado. Es por ello que este tratamiento debe indicarse cuando la probabilidad de supervivencia del paciente tras ser sometido a trasplante hepático sea claramente superior a la esperada con el tratamiento convencional, o cuando su calidad de vida como consecuencia de su enfermedad hepática es inaceptable. Dentro de las indicaciones del trasplante hepático han de tenerse en cuenta tres aspectos fundamentales: las enfermedades hepáticas subsidiarias de tratamiento mediante trasplante, el momento adecuado para la realización del mismo y las contraindicaciones de este procedimiento.

Objetivo: el trasplante hepático es el tratamiento de elección para la falla hepática aguda y crónica. Los resultados en el trasplante hepático han mejorado en los últimos años, así que el objetivo de nuestro trabajo es comparar la experiencia de un centro en Colombia en dos períodos de tiempo diferentes. Pacientes y métodos: estudio descriptivo retrospectivo donde se analizaron pacientes adultos con primer trasplante hepático en dos períodos; serie 1, entre 2004-2010 (241 pacientes); y serie 2, entre 2011-2016 (142 pacientes). Resultados: la edad promedio fue de 54 años, el 57 % eran hombres y con un puntaje Model for End-stage Liver Disease (MELD) promedio de 20, sin cambios significativos en las características del donante y del receptor en los dos períodos. Las principales indicaciones de trasplante hepático fueron cirrosis por alcohol, cirrosis criptogénica y cirrosis por hepatitis autoinmune, con una disminución de los casos de hepatitis B y C en la serie 2. El 30 % de los pacientes tenía hepatocarcinoma. La supervivencia de los pacientes a 1 año fue de 81 % frente a 91 % y a 5 años fue de 71 % frente a 80 %, respectivamente. Las principales causas de muerte fueron: cáncer, enfermedad cardiovascular y sepsis. Existió un incremento significativo en las complicaciones biliares, sin diferencias en las complicaciones infecciosas, vasculares y el rechazo celular entre los dos períodos. Conclusión: el trasplante hepático en este centro en Colombia se relaciona con excelentes resultados a corto y mediano plazo, con una mejoría significativa en la supervivencia de los pacientes en los últimos años y con resultados similares a los reportados en otros centros del mundo.

Resumen El trasplante hepático es el segundo trasplante de órgano sólido más importante en número en nuestro entorno. El objetivo de este estudio es fundamentar la medida en la que el cuidado se ve afectado tras este proceso vital. El método utilizado ha sido el deductivo, mediante la extracción de conocimiento a través de la bibliografía y la posterior formalización lógica de la relación entre los problemas de cuidados más comúnmente presentes en las personas sometidas a un trasplante hepático y las características de las mismas, con el fin de determinar el grado de afectación de los ítems señalados. El marco teórico predominante en este trabajo es el modelo de Dorothea Orem.

The goal of the Spanish Society for Liver Transplantation (La Sociedad Española de Trasplante Hepático) 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., (Copyright © 2023 Asociación Española de Cirugía and Asociación Española de Gastroenterología (AEG). Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The non-invasive diagnostic study of cardiovascular risk in patients who are going to undergo liver transplantation is not clear, especially in asymptomatic patients. Regarding myocardial perfusion scintigraphy (MPS), it has been thought that the impaired vasodilator reserve in these patients may reduce its performance. The objective is to assess the role of the MPS in the pre-surgical evaluation of patients who are going to undergo liver transplantation., Material and Methods: Retrospective, descriptive and observational study was designed. All adult patients undergoing liver transplantation between 2017 and 2021 who had previous MPS were included. The findings of MPS were described and correlated with the findings of invasive angiography and with the appearance or not of peri- and post-transplant cardiovascular events., Results: There were a total of 188 transplanted patients (mean age: 57 years, SD: 12), 178 had previous myocardial perfusion, 82 (46%) patients had no cardiovascular risk factors, and 5 (2.8%) had a history of coronary disease. Of the MPS, 177 were with dipyridamole stress performed on average 10 months before transplantation. Only 17/178 (9.5%) studies were abnormal. The mean follow-up was 38 months (SD: 10). Of the patients with normal MPS, only 2 (1.2%) presented cardiovascular events, both with studies performed more than 2 years before the procedure. There were no deaths of cardiovascular origin., Conclusions: MPS is a safe and reliable technique for cardiovascular assessment of patients who are candidates for liver transplantation, given the low rate of false negatives during follow-up., (Copyright © 2023 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)