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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Orthotopic liver transplant &#40;OLT&#41; is the main therapeutic approach for patients with a severe liver disease but insofar as clinical results of transplant have steadily improved&#44; a shortage of donors has emerged as a serious problem&#44; evidencing the necessity for the best possible donor-recipient matching&#46; With a rising demand for organs and a steady improvement in immunosuppression strategies&#44; more and more marginal donors and recipients will be transplanted&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a> thus the number of dysfunctional allografts might increase&#59; therefore clear criteria to set limits of reasonable acceptance of marginal donors and recipients is paramount to achieve the best performance in OLT policies&#46; In this scenario&#44; identifying those risk factors that signal early liver allograft dysfunction &#40;EAD&#41; can give us some indications for the best donor-recipient matching according to their outcome&#44; but would also allow us a prompt diagnosis and apply early measures that could diminish the intensity or even arrest the development of EAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Defining EAD after OLT is a difficult task due lack of consensus among researchers&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#8211;9</span></a> Almost all criteria proposed to date rely on the determination of widely used markers of hepatic function&#44; such as transaminases&#44; coagulation factors&#44; bilirubin&#44; ammonia and&#47;or lactate&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> but there is a lack of agreement about which ones should be applied&#46; Moreover&#44; some criteria also include less common parameters&#44; such as the rate of elimination of molecules cleared by the liver &#40;e&#46;g&#46;&#44; indocyanine green or C-Methacetin&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">11&#8211;13</span></a> Different classifications define diverse grades of dysfunction &#40;some as dichotomous&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">12&#44;14&#8211;25</span></a> some as progressively graded<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;26&#8211;30</span></a> and finally a few as a numeric value<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">31&#8211;33</span></a>&#41; based on different intervals of these parameters&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a search of the literature using PubMed regarding liver allograft dysfunction criteria&#44; we retrieved 38 definitions since 1985&#44; most of them including some but not all of the aforementioned parameters&#44; besides the presence of overt clinical evidence of primary non-function&#46; This lack of agreement explains why&#44; depending on the criterion selected&#44; EAD after OLT is reported to appear with a broad range &#40;8&#8211;29&#37;&#41;&#44; and the same applies to primary non-function &#40;1&#8211;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim was to evaluate the capability of some of these criteria&#44; specifically those developed by Makowka et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> Ardite et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> Nanashima et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> Dhillon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> and Pareja et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a> for detecting EAD using as comparator the United Network for Organ Sharing &#40;UNOS&#41; criterion for primary non-function<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a> and their relationship with outcome &#40;hospital mortality and 2-year survival&#41; in our population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted an observational&#44; prospective&#44; longitudinal&#44; single center study registering a cohort of all OLT patients admitted to our Unit during the period of study&#46; For the design of the study and the preparation of the manuscript&#44; we adhered to Strengthening the Reporting of Observational Studies in Epidemiology &#40;STROBE&#41; recommendations&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Settings</span><p id="par0030" class="elsevierStylePara elsevierViewall">Intensive Care Unit &#40;ICU&#41; 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age less than 18 years for recipients&#44; refusal from patient or her&#47;his representative to participate in the study&#44; and emergent OLT after acute liver failure&#46; This last exclusion criteria was because that kind of patients usually has different liver function test profiles than rest of recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical and laboratory data were collected and&#47;or registered prospectively in an electronic health record that has not changed over this period and for which all the ICU team has been trained&#46; As per hospital protocol&#44; blood samples were obtained at least on admission in the ICU and then every 12<span class="elsevierStyleHsp" style=""></span>h until ICU discharge&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Definitions</span><p id="par0055" class="elsevierStylePara elsevierViewall">We made a pragmatic selection of criteria for comparison&#44; choosing those which contains variables already measured our hospital protocol for the monitoring of graft function and were easily calculated in most of the clinical scenarios during the first 72<span class="elsevierStyleHsp" style=""></span>h&#46; Those criteria used for the diagnosis of EAD in our study are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In their original description&#44; UNOS criterion is evaluated in the first week&#59; Dhillon and Nanashima criteria at 48<span class="elsevierStyleHsp" style=""></span>h and Ardite and MEAF criteria on the third day after OLT&#46; For the purpose of the study&#44; we have analyzed the performance of all these criteria in the first 72<span class="elsevierStyleHsp" style=""></span>h after OLT&#44; splitting our sample in two&#58; those patients having their most severe grade and those with mild-moderate or nil grade of dysfunction&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The MEAF criterion was developed when our study was closing&#44; but insofar as all the comprising variables were registered prospectively in our database&#44; we opted for its inclusion in the study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">We used UNOS as a reference for comparison between criteria&#46; For the analysis of their relation to outcome&#44; ICU&#44; Hospital and 2-year follow-up mortality were registered&#46; As secondary outcome variables&#44; ICU and hospital length of stay were included&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Continuous variables are presented as median and interquartile range&#46; Categorical variables are presented as percentages&#46; Normality was tested with the Kolmogorov&#8211;Smirnov equation&#46; Chi-square&#44; U-Mann&#8211;Whitney and Kruskal&#8211;Wallis tests where used&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 threshold was used for all tests&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Cohen&#39;s Kappa statistics and its 95&#37; confidence interval were used to evaluate concordance between criteria&#46; The criteria for its application was&#58; poor concordance for a <span class="elsevierStyleItalic">K</span> value &#60;0&#46;20&#44; mild for <span class="elsevierStyleItalic">K</span> between 0&#46;21 and 0&#46;40&#44; fair 0&#46;41 and 0&#46;60&#44; good 0&#46;61 and 0&#46;80 and very good &#62;0&#46;80&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In order to test the behavior of the EAD criteria as predictors of outcome&#44; a model of logistic regression was computed for each criterion by backward conditional stepwise method&#44; including said criterion plus all variables that showed a statistical relationship below 0&#46;1 in the univariate analysis and ICU and in-hospital mortality as dependent variables&#59; results are presented as Odds ratio &#40;95&#37; confidence interval&#41;&#46; For the analysis of 2-year survival&#44; a Kaplan&#8211;Meier curve was computed&#44; and comparisons made by Log-rank test&#59; a model of Cox regression was computed for each criterion by backward conditional stepwise method&#44; including said criterion plus all variables that showed a statistical relationship below 0&#46;1 in the univariate analysis&#59; results are shown as Hazard ratio &#40;95&#37; confidence interval&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally&#44; a receiver operating characteristics &#40;ROC&#41; curve was drawn for each criterion against mortality and its correspondent area under the curve &#40;95&#37; confidence interval&#41; was calculated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">For statistical analysis and creation of figures&#44; we used the statistical package R 3&#46;1&#46;2 for Os X and Prism 6 for Mac Os X &#40;GraphPad Software Inc&#174;&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical issues</span><p id="par0100" class="elsevierStylePara elsevierViewall">The study protocol was in full compliance with the ethical principles of the Declaration of Helsinki and with the Good Clinical Practice guidelines&#46; The study was approved by Committee for Ethics in Research of the Regional University Hospital of M&#225;laga&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Patients or closest relatives signed at admission in the ICU an agreement for the use of the registered clinical data of the patients&#46; All the laboratory data collected were already included in the usual hospital management protocol for these patients in our center&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Patient&#39;s data were registered in a disaggregated database&#44; and identification data were erased once the integrity of the registered data had been evaluated&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">During the study&#44; 272 patients were admitted to our unit after OLT&#44; of them&#44; 19 showed exclusion criteria leaving us 253 patients for analysis&#46; Main characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Mortality in our series was 17&#46;4&#37; &#40;44 patients&#41;&#58; 12 &#40;4&#46;7&#37;&#41; in the early postoperative course at the ICU&#44; 7 &#40;2&#46;8&#37;&#41; in the hospital after ICU discharge and 25 &#40;9&#46;9&#37;&#41; during 2-year follow-up after hospital discharge&#46; Cause for postoperative &#40;in-hospital&#41; mortality was acute rejection in 1 patient&#44; primary non-function in 4&#44; vascular complications in 4 and multi-organ failure after a complicated ICU course in 10 &#40;one secondary to infection&#41;&#46; During the two-year follow-up period&#44; causes of mortality were motivated by graft problems in 14 cases&#58; rejection in 2 &#40;8&#37;&#41; patients&#44; vascular complications in 5 &#40;20&#37;&#41;&#44; a recurring disease in 6 &#40;4&#37;&#41; and biliary complication in 1 &#40;4&#37;&#41;&#46; None of the patients with past medical history of hepatocellular carcinoma died&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">According to UNOS criterion&#44; we diagnosed 35 cases of severe EAD &#40;13&#46;8&#37;&#41;&#44; but by Makowka they would have been 16 &#40;6&#46;3&#37;&#41;&#44; by Ardite 27 &#40;10&#46;7&#37;&#41;&#44; by Nanashima 52 &#40;20&#46;6&#37;&#41;&#44; by Dhillon 78 &#40;30&#46;8&#37;&#41;&#44; and by MEAF criterion 34 cases &#40;13&#46;4&#37;&#41;&#46; In order to assess the concordance between those criteria and UNOS&#44; we calculated Cohen&#39;s Kappa statistic&#44; that showed only fair concordance for all of them&#58; Nanashima 0&#46;55 &#40;0&#46;39&#8211;0&#46;68&#41;&#44; Ardite 0&#46;49 &#40;0&#46;47&#8211;0&#46;50&#41;&#44; Makowka 0&#46;46 &#40;04&#46;29&#8211;0&#46;6&#41;&#44; Dhillon 0&#46;44 &#40;0&#46;32&#8211;0&#46;56&#41; and MEAF 0&#46;41 &#40;0&#46;25&#8211;0&#46;58&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding the univariate analysis&#44; the relationship between EAD diagnosed by each criterion and ICU length of stay&#44; hospital length of stay and mortality are depicted in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">We next performed a multivariate logistic regression and a ROC curve analysis for each one of the EAD diagnostic criteria looking for an independent relationship between these and ICU or Hospital mortality&#44; and the results are presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; This table shows only the OR for each criterion analyzed but in the final step of all the models age&#44; gender&#44; comorbidities&#44; etiology of end-stage liver disease and MELD were excluded and only chronic kidney disease&#44; APACHE II at admission&#59; acute kidney injury during the postoperative period and previous OLT remained in he model&#46; Goodness-of-fit was tested with the Hosmer&#8211;Lemeshow test &#40;<span class="elsevierStyleItalic">p</span> 0&#46;43&#41;&#46; Finally&#44; we analyzed 2-year survival&#44; and the results are presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows only the HR for each criterion analyzed but in the final step of the Cox regression analysis for each model&#44; only etiology of end-stage liver disease and acute kidney injury during the postoperative period remained&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">We designed the present study to assess the performance of various criteria to diagnose EAD and their relationship with outcome&#46; Diagnosing EAD is a challenge because of a large number of criteria proposed&#44; as a consequence&#44; its epidemiology is not well characterized yet&#46; To further complicate this scenario&#44; studies comparing EAD criteria are scarce and whilst most of them intend to validate new sets of variables&#44; almost none has established comparisons among existing criteria&#44; and no study has encompassed them all&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Incidence of EAD reported by several research groups differs from ours&#58; primary non-function by UNOS criterion was 13&#46;8&#37; in our population&#59; Makowka<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> reported poor function in 17&#46;5&#37; against 6&#46;3&#37; in our population&#44; and Ardite<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> reported a 19&#37; of severe initial graft injury&#44; whereas in our series just 10&#46;7&#37; were detected&#46; Closer results were found for Nanashima<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> &#40;reporting 18&#46;3&#37; &#8220;initial poor graft function&#8221; against ours 20&#46;6&#37;&#41; or Dhillon<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> &#40;26&#37; of &#8220;initial poor graft function&#8221; against ours 30&#46;8&#37;&#41;&#46; Our results disclose a huge variability in EAD diagnosis depending on the criteria used&#44; as it is also pointed out in a recent review by Chen&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Several factors could account for these differences&#58; the fact that they were single-center studies or with a retrospective design&#44; or perhaps the advances in the care for OLT&#44; as the incidence of EAD and other complications seems to be decreasing despite marginal donor use&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">37</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In our current settings of a limited number of donors&#44; the appearance of EAD after OLT implies a double problem&#58; a complicated postoperative course with risk for the receptor&#44; and the possibility that in a different recipient this complication would not have developed&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">38</span></a> Thus&#44; it is necessary to accurately define risk factors for EAD but this is difficult due to lack of consensus among researchers about how to define it&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#8211;8</span></a> Obviously&#44; this lack of consensus is detrimental to the design of research strategies that could help clinicians to decide and treat these patients&#44; hampering&#44; in the end&#44; our capability to improve the transplant process&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Our main challenge when comparing these diagnostic sets was how to measure their performance&#46; As definite criteria &#8211; either analytical or pathological &#8211; are lacking&#44; we decided to analyze their capability to predict early and late outcome &#40;e&#46;g&#46;&#44; length of stay or mortality&#41; insofar as there is a clear relationship between EAD and poor outcome&#46; This relationship has been confirmed in our population&#44; where we found an increased length of stay and mortality for those patients developing EAD&#44; irrespective of the diagnostic set used &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">According to our results&#44; the UNOS&#44; MEAF&#44; Makowka&#44; Ardite&#44; and Nanashima criteria showed a good performance in predicting ICU mortality and all of them performed well predicting ICU length of stay&#46; This was expected as most of these criteria were developed for the first postoperative week&#44; despite the poor concordance shown by weak Kappa values&#44; which points to a different set of patients detected by each criterion&#46; Nevertheless&#44; the capability to discriminate ICU mortality was poor according to ROC curve for all the criteria&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">When addressing in-hospital mortality&#44; all the criteria except MEAF showed a poor relationship&#46; In our cohorts&#44; MEAF performed well for in-hospital mortality&#44; in agreement with the results reported in the original publication and in an external validation cohort&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">33&#44;36</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Among all the criteria analyzed in this study&#44; the UNOS&#44; Makowka&#44; and MEAF criteria showed the better relationship with an early and late outcome and among them the MEAF score outperformed&#46; Similar results have been reported from one study comparing the MEAF score with the widely used criteria proposed by Olthoff et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">We must acknowledge some limitations of our study&#46; As in all previous studies addressing EAD&#44; criteria were based on clinical and laboratory parameters that&#44; in some way or another&#44; mark a group of patients with a poorer outcome&#44; but corresponding pathological findings &#40;that could definitely ascertain that EAD is responsible for the clinical picture&#41; are lacking&#46; Despite this&#44; taking into account different criteria already used in clinical practice and comparing their performance&#44; even when lacking definitive confirmation of EAD&#44; can be of aid in defining which of these tools behave better in our population to predict morbidity and mortality&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition&#44; a limitation of this study is the single-center setting&#44; which restricts the external validity of our results&#46; Being a study about diagnostic criteria this aspect is critical&#44; but the OLT patient and the transplant process are well characterized&#44; and our team has large experience in its management&#46; Criteria for graft allocation&#44; patient selection&#44; surgical approach and immunosuppressive regimes are widely agreed and there is scarce variability among centers&#44; so our data can be reasonably extrapolated to other groups&#46; Moreover&#44; comparison of these criteria in different populations helps to precise the validity of these tools&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Part of the problem when studying EAD is the relatively low incidence&#44; making desirable multicenter studies with larger and more varied populations&#46; Also&#44; in order to make sound comparisons&#44; we included as EAD only the severe cases for Makowka&#44; Ardite&#44; Dhillon&#44; and MEAF criteria&#59; if we had also included patients with mild dysfunction&#44; comparisons would not have been clinically consistent&#44; and results would have been even poorer with those criteria&#46; Taken these facts into account&#44; we believe that our results are fair and mark the path for new studies on this topic&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Another possible drawback is that one group of patients was excluded from the study&#44; namely acute liver failure&#46; Our decision was motivated by the possibility of a different behavior of markers of cytolysis&#46; Taking into account that all the criteria included in the study rely heavily on transaminases levels&#44; inclusion of those patients would have potentially biased the results as they present with a serious derangement of liver function parameters before surgery and a different profile of cytolysis markers in the first hours after the transplant can be expected&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a> Thus&#44; we believe that the exclusion of these group assured a more homogeneous profile within our population and strengthened the results&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Still other aspect that can be challenged in our protocol is the inclusion of a score that was published in the last stages of patient&#39;s recruitment&#44; namely the MEAF criterion&#46; Even when this decision breaks the integrity of the &#8220;prospective&#8221; condition of the study&#44; we opted for this strategy because&#44; based on the first reports published&#44; this was a promising diagnostic tool that needed external validation&#44; and the set of parameters that compound the criterion had been prospectively registered in all our patients&#46; Moreover&#44; all the variables included in this criterion are routinely used and the laboratory procedures are standardized and have not suffered significant variations during the period of study&#46; Thus&#44; we assumed that this approach did not compromise the validity of our conclusion and could even add usefulness to the study&#44; as it helped to evaluate this new diagnostic tool&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In summary&#44; when comparing different severe EAD criteria against UNOS criterion we found that all show poor in-between concordance&#46; MEAF criterion showed in our population the best performance to predict short and long term mortality and if these results are confirmed in wider population studies&#44; this could be a useful tool for the characterization of EAD after OLT&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authorship</span><p id="par0210" class="elsevierStylePara elsevierViewall">All author participated in writing and revising the paper&#46; H&#46;G&#46;M&#46;E&#44; S&#46;P&#46;G&#44; and B&#46;F&#46;J&#46;E contributed to design&#44; the performance of research&#44; data collection&#44; and analysis&#46; A&#46;V&#46;M&#46;D and L&#46;S&#46;R contributed to the performance of research and data collection&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0215" class="elsevierStylePara elsevierViewall">This work has not received external funding&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">None of the authors declare any kind of conflict with the contents of the present manuscript&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of different diagnostic criteria for early liver allograft dysfunction &#40;EAD&#41; and their capability to predict mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Single-center&#44; prospective&#44; cohort study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Settings</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ICU in a Regional Hospital with a liver transplant program since 1997&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">253 consecutive patients admitted to our ICU immediately after liver transplantation between 2009 and 2015&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Variables of interest</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Differences in the incidence of EAD and its relation with ICU&#44; Hospital and 2-year mortality depending on the definition applied using as comparator the UNOS &#40;United Network for Organ Sharing&#41; primary non-function criterion&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The incidence of early liver allograft dysfunction according to UNOS was 13&#46;8&#37;&#44; to Makowka 6&#46;3&#37;&#44; to Ardite 10&#46;7&#37;&#44; to Nanashima 20&#46;6&#37;&#44; to Dhillon 30&#46;8&#37; and to MEAF 13&#46;4&#37;&#46; Kappa test did not show a good correlation among these criteria&#46; EAD was related with ICU mortality for all diagnostic criteria except Dhillon but only UNOS&#44; Makowka and MEAF were associated with 2-year mortality&#46; Hospital mortality was poorly predicted by all criteria except for the MEAF score&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We found a poor agreement between different criteria analyzed for the diagnosis of EAD&#46; In our population&#44; the MEAF score showed the best relationship with short- and long-term mortality&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparar diferentes criterios diagn&#243;sticos de disfunci&#243;n temprana del aloinjerto hep&#225;tico y su capacidad para predecir mortalidad&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo&#44; unic&#233;ntrico&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Unidad de Cuidados Intensivos de un Hospital Regional con programa de trasplante hep&#225;tico desde 1997&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pacientes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">253 pacientes consecutivos ingresados en nuestra UCI inmediatamente despu&#233;s del trasplante entre 2009&#8211;2015&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Variables de inter&#233;s</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Incidencia de disfunci&#243;n temprana del aloinjerto hep&#225;tico seg&#250;n cada criterio diagn&#243;stico&#44; relaci&#243;n entre disfunci&#243;n grave acorde a cada criterio y mortalidad en UCI&#44; mortalidad hospitalaria y a los 2 a&#241;os utilizando como comparador el criterio para fallo primario de la UNOS &#40;United Network for Organ Sharing&#41;&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La incidencia de disfunci&#243;n temprana seg&#250;n UNOS fue 13&#46;8&#37;&#44; Makowka 6&#46;3&#37;&#44; Ardite 10&#46;7&#37;&#44; Nanashima 20&#46;6&#37;&#44; Dhillon 30&#46;8&#37; y MEAF 13&#46;4&#37;&#46; El coeficiente kappa mostr&#243; una pobre correlaci&#243;n entre ellos&#46; Todos los criterios&#44; excepto el de Dhillon&#44; mostraron relaci&#243;n con la mortalidad en la UCI&#44; pero solo los criterios de UNOS&#44; Makowka y MEAF se asociaron con la mortalidad a 2 a&#241;os&#46; Finalmente&#44; la capacidad predictiva de la mortalidad hospitalaria fue baja para todos&#44; excepto para MEAF&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Existe una pobre correlaci&#243;n entre diferentes criterios diagn&#243;sticos de disfunci&#243;n temprana del injerto hep&#225;tico&#46; El MEAF muestra la mejor relaci&#243;n con el pron&#243;stico a corto y largo plazo en nuestra poblaci&#243;n&#46;</p></span>"
        "secciones" => array:7 [
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            "identificador" => "abst0040"
            "titulo" => "Objetivo"
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            "identificador" => "abst0045"
            "titulo" => "Dise&#241;o"
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          2 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "&#193;mbito"
          ]
          3 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Pacientes"
          ]
          4 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Variables de inter&#233;s"
          ]
          5 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Resultados"
          ]
          6 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
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        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1724
            "Ancho" => 2500
            "Tamanyo" => 220064
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        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Flow-chart of patient&#39;s recruitment and outcome&#46;</p>"
        ]
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 3615
            "Ancho" => 2506
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Impact of early graft dysfunction on two-year survival&#46; One Kaplan&#8211;Meier curve is presented for each diagnostic method applied for early graft dysfunction&#46; <span class="elsevierStyleItalic">EAD</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">early allograft dysfunction&#46; Comparisons by Log-rank test&#44; HR stands for Hazard ratio</span> &#40;<span class="elsevierStyleItalic">95&#37; confidence interval</span>&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ALT&#58; alanine aminotransferase&#59; AST&#58; aspartate aminotransferase&#59; INR&#58; international normalized ratio&#59; PT&#58; protrombin time&#59; TBil&#58; total bilirubin&#59; UNOS&#58; United Network for Organ Sharing&#59; MEAF&#58; model for early allograft function scoring&#59; max&#46;3POD&#58; maximum value in the first 3 postoperative days&#59; 3POD&#58; third postoperative day&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Criterion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grade&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Criteria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-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">UNOS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT&#47;INR&#47;pH&#47;lactate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primary non-function&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>3000<span class="elsevierStyleHsp" style=""></span>U&#47;L and&#58; INR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2&#46;5 and&#47;or arterial pH<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>7&#46;3 and&#47;or venous pH<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>7&#46;25 and&#47;or lactate<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Makowka &#40;1987&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">ALT&#47;AST&#47;PT</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">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT between 1000 and 2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; AST between 1500 and 3500<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; PT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\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">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; AST<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>3500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Ardite &#40;1999&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">ALT</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">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\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">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">Nanashima &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT&#47;AST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AST or ALT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Dhillon &#40;2010&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">AST&#43;ALT&#47;2</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">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">285&#8211;986<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\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">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;986<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MEAF &#40;2015&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleInf">max&#46;3POD</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scoreINR<span class="elsevierStyleInf">max&#46;3POD</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scorebilirubin<span class="elsevierStyleInf">3POD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dysfunction&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Biliary&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cryptogenic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;5&#46;5&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \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"><span class="elsevierStyleItalic">Previous morbidity &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleHsp" style=""></span>Chronic renal disease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;11&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;27&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;24&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Hepatocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;35&#46;6&#41;&nbsp;\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"><span class="elsevierStyleItalic">Females &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;23&#46;5&#41;&nbsp;\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"><span class="elsevierStyleItalic">Previous OLT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;48&#46;5&#8211;63&#41;&nbsp;\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"><span class="elsevierStyleItalic">Creatinine base &#40;mgr&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;9 &#40;0&#46;7&#8211;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleItalic">MELD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;11&#8211;21&#41;&nbsp;\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"><span class="elsevierStyleItalic">CHILD-PUGH C</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97 &#40;41&#46;3&#41;&nbsp;\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"><span class="elsevierStyleItalic">Ascites</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">L</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;55&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ALT &#40;IU&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">639 &#40;357&#46;5&#8211;1176&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleItalic">INR</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;91 &#40;1&#46;66&#8211;2&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Factor V &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MEAF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;3&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hospital length of stay</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Makowka&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ardite&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;9&#8211;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nanashima&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;8&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dhillon&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;8&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MEAF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11 &#40;8&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19 &#40;11&#8211;26&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ICU mortality</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UNOS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#47;218 &#40;1&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;35 &#40;22&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Makowka&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;237 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#47;16 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Ardite&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#47;226 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#47;27 &#40;18&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Nanashima&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#47;201 &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;52 &#40;15&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Dhillon&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#47;175 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#47;78 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>MEAF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&#47;219 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#47;34 &#40;20&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hospital mortality</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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Original article
Early graft dysfunction after liver transplant: Comparison of different diagnostic criteria in a single-center prospective cohort
Disfunción temprana del injerto tras trasplante hepático: Comparación de varios criterios diagnósticos en un estudio unicéntrico, prospectivo y de cohorte
J.E. Barrueco-Francionia,b, G. Seller-Péreza, R. Lozano-Saéza, M.D. Arias-Verdúa, G. Quesada-Garcíaa, M.E. Herrera-Gutiérreza,b,
Corresponding author
mehguci@gmail.com

Corresponding author.
a Intensive Care Medicine Unit, Regional University Hospital of Malaga, Spain
b Faculty of Medicine, University of Malaga, Spain
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        "titulo" => "Disfunci&#243;n temprana del injerto tras trasplante hep&#225;tico&#58; Comparaci&#243;n de varios criterios diagn&#243;sticos en un estudio unic&#233;ntrico&#44; prospectivo y de cohorte"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Orthotopic liver transplant &#40;OLT&#41; is the main therapeutic approach for patients with a severe liver disease but insofar as clinical results of transplant have steadily improved&#44; a shortage of donors has emerged as a serious problem&#44; evidencing the necessity for the best possible donor-recipient matching&#46; With a rising demand for organs and a steady improvement in immunosuppression strategies&#44; more and more marginal donors and recipients will be transplanted&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a> thus the number of dysfunctional allografts might increase&#59; therefore clear criteria to set limits of reasonable acceptance of marginal donors and recipients is paramount to achieve the best performance in OLT policies&#46; In this scenario&#44; identifying those risk factors that signal early liver allograft dysfunction &#40;EAD&#41; can give us some indications for the best donor-recipient matching according to their outcome&#44; but would also allow us a prompt diagnosis and apply early measures that could diminish the intensity or even arrest the development of EAD&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">2&#8211;6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Defining EAD after OLT is a difficult task due lack of consensus among researchers&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#8211;9</span></a> Almost all criteria proposed to date rely on the determination of widely used markers of hepatic function&#44; such as transaminases&#44; coagulation factors&#44; bilirubin&#44; ammonia and&#47;or lactate&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">10</span></a> but there is a lack of agreement about which ones should be applied&#46; Moreover&#44; some criteria also include less common parameters&#44; such as the rate of elimination of molecules cleared by the liver &#40;e&#46;g&#46;&#44; indocyanine green or C-Methacetin&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">11&#8211;13</span></a> Different classifications define diverse grades of dysfunction &#40;some as dichotomous&#44;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">12&#44;14&#8211;25</span></a> some as progressively graded<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;26&#8211;30</span></a> and finally a few as a numeric value<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">31&#8211;33</span></a>&#41; based on different intervals of these parameters&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a search of the literature using PubMed regarding liver allograft dysfunction criteria&#44; we retrieved 38 definitions since 1985&#44; most of them including some but not all of the aforementioned parameters&#44; besides the presence of overt clinical evidence of primary non-function&#46; This lack of agreement explains why&#44; depending on the criterion selected&#44; EAD after OLT is reported to appear with a broad range &#40;8&#8211;29&#37;&#41;&#44; and the same applies to primary non-function &#40;1&#8211;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our aim was to evaluate the capability of some of these criteria&#44; specifically those developed by Makowka et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> Ardite et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> Nanashima et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> Dhillon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> and Pareja et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">33</span></a> for detecting EAD using as comparator the United Network for Organ Sharing &#40;UNOS&#41; criterion for primary non-function<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">34</span></a> and their relationship with outcome &#40;hospital mortality and 2-year survival&#41; in our population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Study design</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted an observational&#44; prospective&#44; longitudinal&#44; single center study registering a cohort of all OLT patients admitted to our Unit during the period of study&#46; For the design of the study and the preparation of the manuscript&#44; we adhered to Strengthening the Reporting of Observational Studies in Epidemiology &#40;STROBE&#41; recommendations&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Settings</span><p id="par0030" class="elsevierStylePara elsevierViewall">Intensive Care Unit &#40;ICU&#41; of a Regional University Hospital in Spain&#46; Ours is a polyvalent ICU that has been caring for the early postoperative course after OLT since 1997 &#40;when the program was started in our center&#41;&#46; During the period covered by this study &#40;2009&#8211;2015&#41; patients were managed according to a hospital management protocol developed by a multidisciplinary team that included all stages of the process &#40;preoperative&#44; operative and postoperative&#41; and this protocol has been maintained without substantial changes along the period of the study&#44; as well as the professionals of the team&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Our protocol includes the majority of cases the use of the piggy-back technique and end to end anastomosis of the common bile duct&#59; immediate postoperative care in our ICU and any of three possible immunosuppressive strategies&#58; calcineurin inhibitors plus steroids &#40;the most frequently used&#41;&#44; mammalian target of rapamycin inhibitors plus steroids&#44; or interleukin 2 receptor antibodies plus steroids&#44; according to patient&#39;s characteristics and past medical history&#46; Graft-recipient match was allocated for every case in accordance with the Spanish National Transplant Organization &#40;ONT&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patient information and data collection</span><p id="par0040" class="elsevierStylePara elsevierViewall">Recruitment was conducted between February 2009 and February 2015&#46; Two years after hospital discharge&#44; survival status of the patient was checked by consultation of their clinical records &#40;all the follow-up consultations after OLT are centralized in our center&#41;&#44; there were no losses in the follow-up&#44; as can be seen in the study recruitment flow-chart &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; All patients admitted to our ICU for postoperative care after OLT that did not present exclusion criteria were enrolled in the study&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Exclusion criteria were&#58; age less than 18 years for recipients&#44; refusal from patient or her&#47;his representative to participate in the study&#44; and emergent OLT after acute liver failure&#46; This last exclusion criteria was because that kind of patients usually has different liver function test profiles than rest of recipients&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical and laboratory data were collected and&#47;or registered prospectively in an electronic health record that has not changed over this period and for which all the ICU team has been trained&#46; As per hospital protocol&#44; blood samples were obtained at least on admission in the ICU and then every 12<span class="elsevierStyleHsp" style=""></span>h until ICU discharge&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Definitions</span><p id="par0055" class="elsevierStylePara elsevierViewall">We made a pragmatic selection of criteria for comparison&#44; choosing those which contains variables already measured our hospital protocol for the monitoring of graft function and were easily calculated in most of the clinical scenarios during the first 72<span class="elsevierStyleHsp" style=""></span>h&#46; Those criteria used for the diagnosis of EAD in our study are described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In their original description&#44; UNOS criterion is evaluated in the first week&#59; Dhillon and Nanashima criteria at 48<span class="elsevierStyleHsp" style=""></span>h and Ardite and MEAF criteria on the third day after OLT&#46; For the purpose of the study&#44; we have analyzed the performance of all these criteria in the first 72<span class="elsevierStyleHsp" style=""></span>h after OLT&#44; splitting our sample in two&#58; those patients having their most severe grade and those with mild-moderate or nil grade of dysfunction&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The MEAF criterion was developed when our study was closing&#44; but insofar as all the comprising variables were registered prospectively in our database&#44; we opted for its inclusion in the study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">We used UNOS as a reference for comparison between criteria&#46; For the analysis of their relation to outcome&#44; ICU&#44; Hospital and 2-year follow-up mortality were registered&#46; As secondary outcome variables&#44; ICU and hospital length of stay were included&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Continuous variables are presented as median and interquartile range&#46; Categorical variables are presented as percentages&#46; Normality was tested with the Kolmogorov&#8211;Smirnov equation&#46; Chi-square&#44; U-Mann&#8211;Whitney and Kruskal&#8211;Wallis tests where used&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 threshold was used for all tests&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Cohen&#39;s Kappa statistics and its 95&#37; confidence interval were used to evaluate concordance between criteria&#46; The criteria for its application was&#58; poor concordance for a <span class="elsevierStyleItalic">K</span> value &#60;0&#46;20&#44; mild for <span class="elsevierStyleItalic">K</span> between 0&#46;21 and 0&#46;40&#44; fair 0&#46;41 and 0&#46;60&#44; good 0&#46;61 and 0&#46;80 and very good &#62;0&#46;80&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In order to test the behavior of the EAD criteria as predictors of outcome&#44; a model of logistic regression was computed for each criterion by backward conditional stepwise method&#44; including said criterion plus all variables that showed a statistical relationship below 0&#46;1 in the univariate analysis and ICU and in-hospital mortality as dependent variables&#59; results are presented as Odds ratio &#40;95&#37; confidence interval&#41;&#46; For the analysis of 2-year survival&#44; a Kaplan&#8211;Meier curve was computed&#44; and comparisons made by Log-rank test&#59; a model of Cox regression was computed for each criterion by backward conditional stepwise method&#44; including said criterion plus all variables that showed a statistical relationship below 0&#46;1 in the univariate analysis&#59; results are shown as Hazard ratio &#40;95&#37; confidence interval&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally&#44; a receiver operating characteristics &#40;ROC&#41; curve was drawn for each criterion against mortality and its correspondent area under the curve &#40;95&#37; confidence interval&#41; was calculated&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">For statistical analysis and creation of figures&#44; we used the statistical package R 3&#46;1&#46;2 for Os X and Prism 6 for Mac Os X &#40;GraphPad Software Inc&#174;&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Ethical issues</span><p id="par0100" class="elsevierStylePara elsevierViewall">The study protocol was in full compliance with the ethical principles of the Declaration of Helsinki and with the Good Clinical Practice guidelines&#46; The study was approved by Committee for Ethics in Research of the Regional University Hospital of M&#225;laga&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Patients or closest relatives signed at admission in the ICU an agreement for the use of the registered clinical data of the patients&#46; All the laboratory data collected were already included in the usual hospital management protocol for these patients in our center&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Patient&#39;s data were registered in a disaggregated database&#44; and identification data were erased once the integrity of the registered data had been evaluated&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><p id="par0115" class="elsevierStylePara elsevierViewall">During the study&#44; 272 patients were admitted to our unit after OLT&#44; of them&#44; 19 showed exclusion criteria leaving us 253 patients for analysis&#46; Main characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Mortality in our series was 17&#46;4&#37; &#40;44 patients&#41;&#58; 12 &#40;4&#46;7&#37;&#41; in the early postoperative course at the ICU&#44; 7 &#40;2&#46;8&#37;&#41; in the hospital after ICU discharge and 25 &#40;9&#46;9&#37;&#41; during 2-year follow-up after hospital discharge&#46; Cause for postoperative &#40;in-hospital&#41; mortality was acute rejection in 1 patient&#44; primary non-function in 4&#44; vascular complications in 4 and multi-organ failure after a complicated ICU course in 10 &#40;one secondary to infection&#41;&#46; During the two-year follow-up period&#44; causes of mortality were motivated by graft problems in 14 cases&#58; rejection in 2 &#40;8&#37;&#41; patients&#44; vascular complications in 5 &#40;20&#37;&#41;&#44; a recurring disease in 6 &#40;4&#37;&#41; and biliary complication in 1 &#40;4&#37;&#41;&#46; None of the patients with past medical history of hepatocellular carcinoma died&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">According to UNOS criterion&#44; we diagnosed 35 cases of severe EAD &#40;13&#46;8&#37;&#41;&#44; but by Makowka they would have been 16 &#40;6&#46;3&#37;&#41;&#44; by Ardite 27 &#40;10&#46;7&#37;&#41;&#44; by Nanashima 52 &#40;20&#46;6&#37;&#41;&#44; by Dhillon 78 &#40;30&#46;8&#37;&#41;&#44; and by MEAF criterion 34 cases &#40;13&#46;4&#37;&#41;&#46; In order to assess the concordance between those criteria and UNOS&#44; we calculated Cohen&#39;s Kappa statistic&#44; that showed only fair concordance for all of them&#58; Nanashima 0&#46;55 &#40;0&#46;39&#8211;0&#46;68&#41;&#44; Ardite 0&#46;49 &#40;0&#46;47&#8211;0&#46;50&#41;&#44; Makowka 0&#46;46 &#40;04&#46;29&#8211;0&#46;6&#41;&#44; Dhillon 0&#46;44 &#40;0&#46;32&#8211;0&#46;56&#41; and MEAF 0&#46;41 &#40;0&#46;25&#8211;0&#46;58&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Regarding the univariate analysis&#44; the relationship between EAD diagnosed by each criterion and ICU length of stay&#44; hospital length of stay and mortality are depicted in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">We next performed a multivariate logistic regression and a ROC curve analysis for each one of the EAD diagnostic criteria looking for an independent relationship between these and ICU or Hospital mortality&#44; and the results are presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; This table shows only the OR for each criterion analyzed but in the final step of all the models age&#44; gender&#44; comorbidities&#44; etiology of end-stage liver disease and MELD were excluded and only chronic kidney disease&#44; APACHE II at admission&#59; acute kidney injury during the postoperative period and previous OLT remained in he model&#46; Goodness-of-fit was tested with the Hosmer&#8211;Lemeshow test &#40;<span class="elsevierStyleItalic">p</span> 0&#46;43&#41;&#46; Finally&#44; we analyzed 2-year survival&#44; and the results are presented in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> and <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows only the HR for each criterion analyzed but in the final step of the Cox regression analysis for each model&#44; only etiology of end-stage liver disease and acute kidney injury during the postoperative period remained&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">We designed the present study to assess the performance of various criteria to diagnose EAD and their relationship with outcome&#46; Diagnosing EAD is a challenge because of a large number of criteria proposed&#44; as a consequence&#44; its epidemiology is not well characterized yet&#46; To further complicate this scenario&#44; studies comparing EAD criteria are scarce and whilst most of them intend to validate new sets of variables&#44; almost none has established comparisons among existing criteria&#44; and no study has encompassed them all&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Incidence of EAD reported by several research groups differs from ours&#58; primary non-function by UNOS criterion was 13&#46;8&#37; in our population&#59; Makowka<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">26</span></a> reported poor function in 17&#46;5&#37; against 6&#46;3&#37; in our population&#44; and Ardite<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">27</span></a> reported a 19&#37; of severe initial graft injury&#44; whereas in our series just 10&#46;7&#37; were detected&#46; Closer results were found for Nanashima<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a> &#40;reporting 18&#46;3&#37; &#8220;initial poor graft function&#8221; against ours 20&#46;6&#37;&#41; or Dhillon<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">29</span></a> &#40;26&#37; of &#8220;initial poor graft function&#8221; against ours 30&#46;8&#37;&#41;&#46; Our results disclose a huge variability in EAD diagnosis depending on the criteria used&#44; as it is also pointed out in a recent review by Chen&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Several factors could account for these differences&#58; the fact that they were single-center studies or with a retrospective design&#44; or perhaps the advances in the care for OLT&#44; as the incidence of EAD and other complications seems to be decreasing despite marginal donor use&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">37</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In our current settings of a limited number of donors&#44; the appearance of EAD after OLT implies a double problem&#58; a complicated postoperative course with risk for the receptor&#44; and the possibility that in a different recipient this complication would not have developed&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">38</span></a> Thus&#44; it is necessary to accurately define risk factors for EAD but this is difficult due to lack of consensus among researchers about how to define it&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">6&#8211;8</span></a> Obviously&#44; this lack of consensus is detrimental to the design of research strategies that could help clinicians to decide and treat these patients&#44; hampering&#44; in the end&#44; our capability to improve the transplant process&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Our main challenge when comparing these diagnostic sets was how to measure their performance&#46; As definite criteria &#8211; either analytical or pathological &#8211; are lacking&#44; we decided to analyze their capability to predict early and late outcome &#40;e&#46;g&#46;&#44; length of stay or mortality&#41; insofar as there is a clear relationship between EAD and poor outcome&#46; This relationship has been confirmed in our population&#44; where we found an increased length of stay and mortality for those patients developing EAD&#44; irrespective of the diagnostic set used &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">According to our results&#44; the UNOS&#44; MEAF&#44; Makowka&#44; Ardite&#44; and Nanashima criteria showed a good performance in predicting ICU mortality and all of them performed well predicting ICU length of stay&#46; This was expected as most of these criteria were developed for the first postoperative week&#44; despite the poor concordance shown by weak Kappa values&#44; which points to a different set of patients detected by each criterion&#46; Nevertheless&#44; the capability to discriminate ICU mortality was poor according to ROC curve for all the criteria&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">When addressing in-hospital mortality&#44; all the criteria except MEAF showed a poor relationship&#46; In our cohorts&#44; MEAF performed well for in-hospital mortality&#44; in agreement with the results reported in the original publication and in an external validation cohort&#46;<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">33&#44;36</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Among all the criteria analyzed in this study&#44; the UNOS&#44; Makowka&#44; and MEAF criteria showed the better relationship with an early and late outcome and among them the MEAF score outperformed&#46; Similar results have been reported from one study comparing the MEAF score with the widely used criteria proposed by Olthoff et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">39</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">We must acknowledge some limitations of our study&#46; As in all previous studies addressing EAD&#44; criteria were based on clinical and laboratory parameters that&#44; in some way or another&#44; mark a group of patients with a poorer outcome&#44; but corresponding pathological findings &#40;that could definitely ascertain that EAD is responsible for the clinical picture&#41; are lacking&#46; Despite this&#44; taking into account different criteria already used in clinical practice and comparing their performance&#44; even when lacking definitive confirmation of EAD&#44; can be of aid in defining which of these tools behave better in our population to predict morbidity and mortality&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In addition&#44; a limitation of this study is the single-center setting&#44; which restricts the external validity of our results&#46; Being a study about diagnostic criteria this aspect is critical&#44; but the OLT patient and the transplant process are well characterized&#44; and our team has large experience in its management&#46; Criteria for graft allocation&#44; patient selection&#44; surgical approach and immunosuppressive regimes are widely agreed and there is scarce variability among centers&#44; so our data can be reasonably extrapolated to other groups&#46; Moreover&#44; comparison of these criteria in different populations helps to precise the validity of these tools&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Part of the problem when studying EAD is the relatively low incidence&#44; making desirable multicenter studies with larger and more varied populations&#46; Also&#44; in order to make sound comparisons&#44; we included as EAD only the severe cases for Makowka&#44; Ardite&#44; Dhillon&#44; and MEAF criteria&#59; if we had also included patients with mild dysfunction&#44; comparisons would not have been clinically consistent&#44; and results would have been even poorer with those criteria&#46; Taken these facts into account&#44; we believe that our results are fair and mark the path for new studies on this topic&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Another possible drawback is that one group of patients was excluded from the study&#44; namely acute liver failure&#46; Our decision was motivated by the possibility of a different behavior of markers of cytolysis&#46; Taking into account that all the criteria included in the study rely heavily on transaminases levels&#44; inclusion of those patients would have potentially biased the results as they present with a serious derangement of liver function parameters before surgery and a different profile of cytolysis markers in the first hours after the transplant can be expected&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">35</span></a> Thus&#44; we believe that the exclusion of these group assured a more homogeneous profile within our population and strengthened the results&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Still other aspect that can be challenged in our protocol is the inclusion of a score that was published in the last stages of patient&#39;s recruitment&#44; namely the MEAF criterion&#46; Even when this decision breaks the integrity of the &#8220;prospective&#8221; condition of the study&#44; we opted for this strategy because&#44; based on the first reports published&#44; this was a promising diagnostic tool that needed external validation&#44; and the set of parameters that compound the criterion had been prospectively registered in all our patients&#46; Moreover&#44; all the variables included in this criterion are routinely used and the laboratory procedures are standardized and have not suffered significant variations during the period of study&#46; Thus&#44; we assumed that this approach did not compromise the validity of our conclusion and could even add usefulness to the study&#44; as it helped to evaluate this new diagnostic tool&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">In summary&#44; when comparing different severe EAD criteria against UNOS criterion we found that all show poor in-between concordance&#46; MEAF criterion showed in our population the best performance to predict short and long term mortality and if these results are confirmed in wider population studies&#44; this could be a useful tool for the characterization of EAD after OLT&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Authorship</span><p id="par0210" class="elsevierStylePara elsevierViewall">All author participated in writing and revising the paper&#46; H&#46;G&#46;M&#46;E&#44; S&#46;P&#46;G&#44; and B&#46;F&#46;J&#46;E contributed to design&#44; the performance of research&#44; data collection&#44; and analysis&#46; A&#46;V&#46;M&#46;D and L&#46;S&#46;R contributed to the performance of research and data collection&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Funding</span><p id="par0215" class="elsevierStylePara elsevierViewall">This work has not received external funding&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conflict of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">None of the authors declare any kind of conflict with the contents of the present manuscript&#46;</p></span></span>"
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    "fechaRecibido" => "2018-07-11"
    "fechaAceptado" => "2018-09-05"
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            0 => "Liver transplantation"
            1 => "Primary graft dysfunction"
            2 => "Primary non function"
            3 => "Criterion"
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          "palabras" => array:7 [
            0 => "Trasplante hep&#225;tico"
            1 => "Disfunci&#243;n primaria del injerto"
            2 => "Fallo primario"
            3 => "Criterios"
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            5 => "Complicaciones postoperatorias"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of different diagnostic criteria for early liver allograft dysfunction &#40;EAD&#41; and their capability to predict mortality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Single-center&#44; prospective&#44; cohort study&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Settings</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">ICU in a Regional Hospital with a liver transplant program since 1997&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">253 consecutive patients admitted to our ICU immediately after liver transplantation between 2009 and 2015&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Variables of interest</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Differences in the incidence of EAD and its relation with ICU&#44; Hospital and 2-year mortality depending on the definition applied using as comparator the UNOS &#40;United Network for Organ Sharing&#41; primary non-function criterion&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The incidence of early liver allograft dysfunction according to UNOS was 13&#46;8&#37;&#44; to Makowka 6&#46;3&#37;&#44; to Ardite 10&#46;7&#37;&#44; to Nanashima 20&#46;6&#37;&#44; to Dhillon 30&#46;8&#37; and to MEAF 13&#46;4&#37;&#46; Kappa test did not show a good correlation among these criteria&#46; EAD was related with ICU mortality for all diagnostic criteria except Dhillon but only UNOS&#44; Makowka and MEAF were associated with 2-year mortality&#46; Hospital mortality was poorly predicted by all criteria except for the MEAF score&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We found a poor agreement between different criteria analyzed for the diagnosis of EAD&#46; In our population&#44; the MEAF score showed the best relationship with short- and long-term mortality&#46;</p></span>"
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        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparar diferentes criterios diagn&#243;sticos de disfunci&#243;n temprana del aloinjerto hep&#225;tico y su capacidad para predecir mortalidad&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo&#44; unic&#233;ntrico&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Unidad de Cuidados Intensivos de un Hospital Regional con programa de trasplante hep&#225;tico desde 1997&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pacientes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">253 pacientes consecutivos ingresados en nuestra UCI inmediatamente despu&#233;s del trasplante entre 2009&#8211;2015&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Variables de inter&#233;s</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Incidencia de disfunci&#243;n temprana del aloinjerto hep&#225;tico seg&#250;n cada criterio diagn&#243;stico&#44; relaci&#243;n entre disfunci&#243;n grave acorde a cada criterio y mortalidad en UCI&#44; mortalidad hospitalaria y a los 2 a&#241;os utilizando como comparador el criterio para fallo primario de la UNOS &#40;United Network for Organ Sharing&#41;&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La incidencia de disfunci&#243;n temprana seg&#250;n UNOS fue 13&#46;8&#37;&#44; Makowka 6&#46;3&#37;&#44; Ardite 10&#46;7&#37;&#44; Nanashima 20&#46;6&#37;&#44; Dhillon 30&#46;8&#37; y MEAF 13&#46;4&#37;&#46; El coeficiente kappa mostr&#243; una pobre correlaci&#243;n entre ellos&#46; Todos los criterios&#44; excepto el de Dhillon&#44; mostraron relaci&#243;n con la mortalidad en la UCI&#44; pero solo los criterios de UNOS&#44; Makowka y MEAF se asociaron con la mortalidad a 2 a&#241;os&#46; Finalmente&#44; la capacidad predictiva de la mortalidad hospitalaria fue baja para todos&#44; excepto para MEAF&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusi&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Existe una pobre correlaci&#243;n entre diferentes criterios diagn&#243;sticos de disfunci&#243;n temprana del injerto hep&#225;tico&#46; El MEAF muestra la mejor relaci&#243;n con el pron&#243;stico a corto y largo plazo en nuestra poblaci&#243;n&#46;</p></span>"
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Impact of early graft dysfunction on two-year survival&#46; One Kaplan&#8211;Meier curve is presented for each diagnostic method applied for early graft dysfunction&#46; <span class="elsevierStyleItalic">EAD</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#61;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">early allograft dysfunction&#46; Comparisons by Log-rank test&#44; HR stands for Hazard ratio</span> &#40;<span class="elsevierStyleItalic">95&#37; confidence interval</span>&#41;&#46;</p>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Makowka &#40;1987&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">ALT&#47;AST&#47;PT</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">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT between 1000 and 2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; AST between 1500 and 3500<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; PT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\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">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&#44; AST<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>3500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Ardite &#40;1999&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">ALT</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">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\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">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">Nanashima &#40;2002&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT&#47;AST&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AST or ALT<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1500<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Dhillon &#40;2010&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">AST&#43;ALT&#47;2</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">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">285&#8211;986<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\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">Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62;986<span class="elsevierStyleHsp" style=""></span>U&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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">MEAF &#40;2015&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ALT<span class="elsevierStyleInf">max&#46;3POD</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scoreINR<span class="elsevierStyleInf">max&#46;3POD</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scorebilirubin<span class="elsevierStyleInf">3POD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dysfunction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8805;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Main indication for OLT &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleHsp" style=""></span>Alcohol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116 &#40;45&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Virus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;30&#46;8&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Biliary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;8&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Cryptogenic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></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"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;9&#46;1&#41;&nbsp;\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"><span class="elsevierStyleItalic">Previous morbidity &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleHsp" style=""></span>Chronic renal disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;11&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;27&#46;7&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;24&#46;9&#41;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Hepatocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90 &#40;35&#46;6&#41;&nbsp;\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"><span class="elsevierStyleItalic">Females &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;23&#46;5&#41;&nbsp;\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"><span class="elsevierStyleItalic">Previous OLT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Age</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;48&#46;5&#8211;63&#41;&nbsp;\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"><span class="elsevierStyleItalic">Creatinine base &#40;mgr&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9 &#40;0&#46;7&#8211;1&#46;05&#41;&nbsp;\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"><span class="elsevierStyleItalic">MELD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;11&#8211;21&#41;&nbsp;\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"><span class="elsevierStyleItalic">CHILD-PUGH C</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97 &#40;41&#46;3&#41;&nbsp;\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"><span class="elsevierStyleItalic">Ascites</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">L</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;55&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2264990.png"
              ]
            ]
            1 => 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">Admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">APACHE II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;1 &#40;13&#46;6&#8211;14&#46;6&#41;&nbsp;\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"><span class="elsevierStyleItalic">SOFA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5 &#40;6&#46;2&#8211;6&#46;9&#41;&nbsp;\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"><span class="elsevierStyleItalic">AST &#40;IU&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1133 &#40;611&#8211;2005&#41;&nbsp;\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"><span class="elsevierStyleItalic">ALT &#40;IU&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">639 &#40;357&#46;5&#8211;1176&#46;5&#41;&nbsp;\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"><span class="elsevierStyleItalic">INR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;91 &#40;1&#46;66&#8211;2&#46;26&#41;&nbsp;\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"><span class="elsevierStyleItalic">Factor V &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;17&#46;2&#8211;36&#46;8&#41;&nbsp;\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"><span class="elsevierStyleItalic">Bilirubin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;5 &#40;2&#46;4&#8211;5&#46;7&#41;&nbsp;\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"><span class="elsevierStyleItalic">Lactate &#40;mmol&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;8 &#40;1&#46;1&#8211;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            2 => 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">ICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-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"><span class="elsevierStyleItalic">Higher AST &#40;IU&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1216 &#40;659&#8211;2413&#41;&nbsp;\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"><span class="elsevierStyleItalic">Higher ALT &#40;IU&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">730 &#40;398&#46;5&#8211;1513&#41;&nbsp;\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"><span class="elsevierStyleItalic">Higher INR</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;95 &#40;1&#46;71&#8211;2&#46;35&#41;&nbsp;\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"><span class="elsevierStyleItalic">Higher bilirubin &#40;mg&#47;dL&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;9 &#40;2&#46;6&#8211;6&#46;3&#41;&nbsp;\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"><span class="elsevierStyleItalic">Higher lactate &#40;mmol&#47;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;15&#46;4&#41;&nbsp;\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"><span class="elsevierStyleItalic">CRRT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;10&#46;3&#41;&nbsp;\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"><span class="elsevierStyleItalic">MARS albumin dialysis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#41;&nbsp;\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"><span class="elsevierStyleItalic">Stay &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#8211;5&#41;&nbsp;\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"><span class="elsevierStyleItalic">ICU mortality</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2264987.png"
              ]
            ]
            3 => 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">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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Article information
ISSN: 21735727
Original language: English
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