Outcome quality standards for surgery of colorectal liver metastasis.

PURPOSE: Liver metastases are the most common malignant solid liver lesions, approximately 40% of which stem from colorectal tumors. Liver resection is currently the only curative treatment for colorectal cancer liver metastases (CRLM). However, there is a lack of consensus criteria to assess the results of this treatment. In order to evaluate the quality of surgical outcomes, it is necessary to identify quality indicators (QIs) and their corresponding quality standards (QS). We propose a simple method to determine QI and QS in CRLM surgery (CRLMS) and establish acceptable quality limits (AQL) for each QI. MATERIAL AND METHODS: A systematic review of CRLMS results published from 2006 to 2016. Clinical guidelines, consensus conferences, and publications related to the CRLMS were reviewed to identify and select QIs. Once selected, a new review of the papers including the results of at least one of the QIs was performed. Statistical process control (SPC) method was applied to calculate the QS and AQL of each QI. The limits of variability were established from mean and confidence intervals at 95% and 99.8%. RESULTS: The most relevant QIs and its AQLs were postoperative mortality (2%, < 4.5%), overall postoperative morbidity (33%, < 41%), liver failure (5%, < 8%), postoperative hemorrhage (1%, < 3%), biliary fistula (6%, < 10%), reoperation (3%, < 6%), R1 resection margins (18%, < 25%), and overall survival at 12 and 60 months (84%, > 77%; and 34%, > 25%, respectively). CONCLUSIONS: Despite its limitations, the present study constitutes the most extensive scientific evidence to date on QI and AQL in CRLMS and may constitute a reference in future studies.

Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients.

Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.

Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery.

OBJECTIVE: To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. BACKGROUND: EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. METHODS: Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. RESULTS: These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement. CONCLUSIONS: EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.

Is physical exercise harmful to liver transplantation recipients? Review of literature.

Liver transplantation is a treatment that significantly improves the patients' quality of life. However, we should be more ambitious and seek an improvement in their fitness through training protocols allowing them to fully return to daily activities. English and Spanish-language articles on PubMed and the Cochrane Library were searched untill 2014. Articles were reviewed by 2 of the authors to determine if they were suitable for inclusion. It is shown a compilation of studies that included patients who have participated in aerobic, strength, or both combined training programs, without implying a risk for the graft function. There is a lack of studies with high scientific evidence that stablish a proper exercise program methodology, supervised by specialists in physical activity and sports.

Cooperative Study of the Spanish Pancreas Transplant Group (GETP): Surgical Complications.

UNLABELLED: Technical failure in pancreas transplant has been the main cause of the loss of grafts. In the last few years, the number of complications has reduced, and therefore the proportion of this problem. OBJECTIVES: The Spanish Pancreas Transplant Group wanted to analyze the current situation with regard to surgical complications and their severity. MATERIAL AND METHODS: A retrospective and multicenter study was performed. 10 centers participated, with a total of 410 pancreas transplant recipients between January and December 2013. RESULTS: A total of 316 transplants were simultaneous with kidney, 66 after kidney, pancreas-only 10, 7 multivisceral and 11 retrasplants. Surgical complication rates were 39% (n=161). A total of 7% vascular thrombosis, 13% bleeding, 6% the graft pancreatitis, 12% surgical infections and others to a lesser extent. Relaparotomy rate was 25%. The severity of complications were of type IIIb (13%), type II (12%) and type IVa (8.5%). Graft loss was 8%. Early mortality was 0.5%. The percentage of operations for late complications was 17%. CONCLUSIONS: The number of surgical complications after transplantation is not negligible, affecting one in 3 patients. They are severe in one out of 5 and, in one of every 10 patients graft loss occurs. Therefore, there is still a significant percentage of surgical complications in this type of activity, as shown in our country.

Monosegment ALPPS: A new variant of the techniques for rapid hepatic regeneration. Critical review of the initial results of our series.

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a novel surgical technique that provides fast and effective growth of liver remnant volume, allowing surgical resection of hepatic lesions initially considered unresectable. Short and long-term results and the convenience of carrying out this technique are issues that still remain under debate while waiting for the final outcomes of the multicenter registries with larger number of cases. The aim of this paper is to describe, from a critical point of view, the outcomes of the cases performed at our center (n=8). On the other hand, it is possible to leave only one hepatic segment as a liver remnant and we illustrate this new surgical procedure (ALPPS monosegment) performed in one patient.

Feasibility and Short-Term Outcomes in Liver-First Approach: A Spanish Snapshot Study (the RENACI Project).

(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.

The Potential Role of Efficacy and Safety Evaluation of N-Acetylcysteine Administration During Liver Procurement. The NAC-400 Single Center Randomized Controlled Trial.

BACKGROUND: N-acetylcysteine infusions have been widely used to reduce ischemia/reperfusion damage to the liver; however, convincing evidence of their benefits is lacking. OBJECTIVE: To perform the largest randomized controlled trial to compare the impact of N-acetylcysteine infusion during liver procurement on liver transplant outcomes. METHODS: Single center, randomized trial with patients recruited from La Fe University Hospital, Spain, from February 2012 to January 2016. A total of 214 grafts were transplanted and randomized to the N-acetylcysteine group (n = 113) or to the standard protocol without N-acetylcysteine (n = 101). The primary endpoint was allograft dysfunction (Olthoff criteria). Secondary outcomes included metabolomic biomarkers of oxidative stress levels, interactions between cold ischemia time and alanine aminotransferase level and graft and patient survival (ID no. NCT01866644). RESULTS: The incidence of primary dysfunction was 34% (31% in the N-acetylcysteine group and 37.4% in the control group [P = 0.38]). N-acetylcysteine administration reduced the alanine aminotransferase level when cold ischemia time was longer than 6 h (P = 0.0125). Oxidative metabolites (glutathione/oxidized glutathione and ophthalmic acid) were similar in both groups (P > 0.05). Graft and patient survival rates at 12 mo and 3 y were similar between groups (P = 0.54 and P = 0.69, respectively). CONCLUSIONS: N-acetylcysteine administration during liver procurement does not improve early allograft dysfunction according to the Olthoff classification. However, when cold ischemia time is longer than 6 h, N-acetylcysteine improves postoperative ALT levels.

Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana.

INTRODUCTION: Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS: Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS: Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.1 ± 3.4 kg/m2, mean duration of diabetes 25.5 ± 6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91.3%, 91.3% and 89.5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2% and 93.6% at one year, 88.2% and 93.7% at 3 years, and 85.3% and 93.7% at 5 years, respectively (P = 1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2%, 69.1% and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5% and 80.6% at one year, 64.7% and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P = .0109). Post-transplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS: In 13 years' experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.

Non-arbitrary minimum threshold of yearly performed pancreatoduodenectomies: National multicentric study.

BACKGROUND: Annual hospital volume of pancreatoduodenectomies could influence postoperative outcomes. The aim of this study is to establish with a non-arbitrary method the minimum threshold of yearly performed pancreatoduodenectomies in order to improve several postoperative quality outcomes. METHOD: Prospective follow-up of patients submitted to pancreatoduodenectomy in participating hospitals during 1 year. The influence of hospital volume on quality outcomes was analyzed by univariable and multivariable models. The minimum threshold of yearly performed pancreatoduodenectomies to improve outcomes was established by Akaike's information criteria. RESULTS: Data from 877 patients operated in 74 hospitals were analyzed. Of 12 quality outcomes, 9 were influenced by hospital pancreatoduodenectomy volume on multivariable analysis. To decrease the risk of complications and the risk of retrieving an insufficient number of lymph nodes at least 31 pancreatoduodenectomies per year should be performed. To decrease the risk of prolonged length of stay, postoperative death, and affected surgical margins, at least 37, 6, and 14 pancreatoduodenectomies per year should be performed, respectively. CONCLUSION: Several postoperative quality outcomes are influenced by the number of yearly performed pancreatoduodenectomies and could be improved by establishing a minimum threshold of procedures. Number of procedures needed to improve quality outcomes has been established by a non-arbitrary method.

[Indications and results of liver retransplantation: experience with 1181 patients at the University Hospital La Fe]. / Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes).

UNLABELLED: Liver retransplantation (LrT) is the only therapeutic option for irreversible failure of a hepatic graft and accounts for 2.9%-24.0% of all liver transplantations (LT). It is technically difficult and has a high level of immediate morbidity and a lower survival than primary LT. Our aim was to determine the rate of LrT and its indications, morbidity, post-operative mortality and actuarial survival in the retransplanted patient. PATIENTS AND METHOD: A historical cohort study of 1181 patients transplanted between 1991 and 2006. RESULTS: Of the 1260 LT performed, 79 were LrT. At the time of the first LT there were no differences between those patients and those that did not require an LrT. The LrT rate was 6.3% and the most frequent causes were: hepatic artery thrombosis (31.6%), recurrence of cirrhosis due the HVC (30.4%) and primary graft (21.5%). The ischemia times, perfusion syndrome and hepatic congestion were no different between the primary LT and the LrT. On the other hand, red cell transfusions were higher in LrT (6.3+/-4.9 vs. 3.5+/-3.0 units, P<0.001). The post-operative morbidity and morbidity (up to 30 days after the LT) was higher in retransplanted patients (68.4% vs. 57.0%, P=0.04 and 25.3% vs. 10.9%, P<0.001; respectively). The actuarial survival at 1 and 5 years was 83% and 69% in those without LrT, 71% and 61% in early LrT and 64% and 34% in delayed LrT (P<0.001). CONCLUSIONS: Despite the increased morbidity and mortality of LrT, it appears that this treatment alternative is still valid in those patients with an early loss of the liver graft. On the other hand, when the graft loss is delayed, it needs to be defined, what would be the minimum acceptable results to indicate LrT and which patients could benefit from this treatment.

Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. / Resultados tras 13 años del inicio del trasplante simultáneo de páncreas-riñón en pacientes con diabetes mellitus tipo 1 en la Comunidad Valenciana.

INTRODUCTION: Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS: Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS: Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4±5.7 years, mean BMI 24.1±3.4kg/m2, mean duration of diabetes 25.5±6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91,3, 91,3 and 89,5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2 and 93.6% at one year, 88.2 and 93.7% at 3 years, and 85.3 and 93.7% at 5 years, respectively (P=1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2, 69.1 and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5 and 80.6% at one year, 64.7 and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P=.0109). Postransplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS: In 13-year's experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.

Clinical Relevance of a Balance Training Program on Liver Transplant Patients. A Randomized Controlled Trial.

BACKGROUND: Although some studies have reported significant improvements in physical function and strength after training programs on liver transplant (LT) recipients, there is a lack of knowledge on how it affects in static and dynamic balance, being an important part of these participants' tasks development. The aim of the study was to determine the effects of a 6-month multicomponent circuit training program on static and dynamic balance in LT participants. METHODS: Fifty-four participants were randomized at 6 months after LT into 2 groups: exercise (EXER) group and control (CONTROL) group, with repeat testing at 6 (baseline) and 12 months after LT. The intervention consisted of a multicomponent training, including balance, strength, endurance, and flexibility training, with exercises arranged in a circuit setup and a moderate intensity with high perceived exertion. Training sessions were performed in the hospital facilities with qualified trainers. To determine differences over time between EXER and CONTROL, mixed-regression linear models with subject variable as random factor and variables of treatment duration, type, and interaction as predictors were used. RESULTS: The EXER group showed significant differences (P < 0.05) compared with CONTROL in all variables of static and dynamic balance, hip strength (49% versus 13%), agility (-16% versus -1%), and flexibility (78% versus -26%). Adherence to the intervention was 94%, and 80% of the participants continued voluntarily training after the 6 months. CONCLUSIONS: This study demonstrated that a multicomponent circuit training program at a moderate intensity with high perceived exertion could reduce the probability of injuries because it improves balance on LT recipients.

Multicentric study on total pancreatectomies. / Estudio multicéntrico nacional sobre pancreatectomías totales.

INTRODUCTION: Total pancreatectomy (TP) is an uncommon operation, with indications that have not been clearly defined and non-standardized postoperative results. We present a national multicentric study on TP and a comparison with the existing literature METHODS: A prospective observational study using data from the national registry of patients after pancreaticoduodenectomy and TP performed for any indication during the study period: January 1 to December 31, 2015 RESULTS: 1016 patients were included from 73 hospitals, 112 of whom had undergone TP. The percentage of TP from the total number of cases was 11%. The mean age was 63.5 years, and 57.2% were males. The most frequently suspected radiological diagnosis was pancreatic cancer (58/112 cases). The most common TP technique was "mesentery artery first" (43/112 cases). Venous resections were performed in 23 patients (20.5%). The percentage of postoperative complications within 90 days was 50%, but major complications (>IIIA) were only 20.7%. The overall 90-day mortality was 8% (9 patients). The average stay was 20.7 days. The 3most frequent definitive histological diagnoses were: adenocarcinoma of the pancreas, intraductal papillary mucinous neoplasm and chronic pancreatitis. The R0 rate was 67.8%. CONCLUSIONS: This study shows that the morbidity and mortality results of TP in Spain are similar or superior to previous publications. More precise TP studies are necessary, focused on specific complications such as endocrine insufficiency.

[Hepatic undifferentiated (embryonal) sarcoma in an adult: a case report and literature review]. / Sarcoma indiferenciado (embrionario) de hígado del adulto: informe de un caso y revisión de la literatura médica.

Undifferentiated (embryonal) sarcoma of the liver (USL) is a rare malignant hepatic tumor in adults. We report the case of a 40-year-old man with USL who was successfully treated with surgical resection and chemotherapy using ifosfamide and adriamycin. To our knowledge, only 70 cases of USL in adults have been reported worldwide in the 40 years since this clinicopathological entity was defined. Although the prognosis of the disease remains generally poor, long term survival has been achieved in patients with a combination of surgery and chemotherapy.

Resultados tras 13 años del inicio del trasplante simultáneo de páncreas-riñón en pacientes con diabetes mellitus tipo 1 en la Comunidad Valenciana / Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana

Introducción: El trasplante simultáneo de páncreas-riñón (SPK, por simultaneous pancreas kidney) es una opción terapéutica válida en pacientes afectos de diabetes mellitus tipo 1 con enfermedad renal crónica terminal que son candidatos a trasplante renal. Se presentan los resultados desde el inicio del programa de trasplante SPK en la Comunidad Valenciana. Métodos: Estudio descriptivo, retrospectivo y unicéntrico de los trasplantes de páncreas realizados en el Hospital Universitari i Politècnic La Fe, desde septiembre de 2002 a diciembre de 2015. Se recogieron variables clínicas de los donantes y receptores, variables peri-operatorias y supervivencia del paciente y del injerto pancreático. Resultados: Ochenta y un pacientes con diabetes mellitus tipo 1 (48 hombres y 33 mujeres, de 37,4±5,7 años, IMC de 24,1±3,4kg/m2, con una duración de su diabetes de 25,5±6,5 años) recibieron un trasplante SPK. La supervivencia global del paciente a uno, 3 y 5 años fue del 91,3, el 91,3 y el 89,5%, respectivamente. Sin embargo, la supervivencia del paciente en los periodos 2002-2008 y 2009-2015 fue del 88,2 y el 93,6% al año, del 88,2 y el 93,7% a los 3 años, y del 85,3 y el 93,7% a los 5 años, respectivamente (p=1). La supervivencia global del injerto pancreático a uno, 3 y 5 años fue del 75,2, el 69,1 y el 63,2%, respectivamente. Por otra parte, la supervivencia del injerto pancreático en los periodos 2002-2008 y 2009-2015 fue del 67,5 y el 80,6% al año, del 64,7 y el 71,8% a los 3 años, y del 58,8 y el 65,3% a los 5 años, respectivamente (p=0,0109). Las complicaciones postrasplante fueron: rechazo del injerto en un 8,6%, trombosis venosa del injerto en un 7,4% y pancreatitis del injerto en un 4,9%. (AU)

Introduction: Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. Methods: Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. Results: Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4±5.7 years, mean BMI 24.1±3.4kg/m2, mean duration of diabetes 25.5±6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91,3, 91,3 and 89,5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2 and 93.6% at one year, 88.2 and 93.7% at 3 years, and 85.3 and 93.7% at 5 years, respectively (P=1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2, 69.1 and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5 and 80.6% at one year, 64.7 and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P=.0109). Postransplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. (AU)

Alterations in carbohydrate metabolism in cirrhotic patients before and after liver transplant.

AIM: The main objective of this study is to demonstrate whether carbohydrate metabolism alterations identified in patients with advanced cirrhosis show any improvement after liver transplant. METHODS: The study included 86 patients who underwent liver transplant between March 2010 and February 2011. An oral glucose tolerance test was performed before the liver transplant, and 6 and 12 months after. Beta cell function and insulin resistance were also calculated, applying formulae that use basal plasma glycaemia and insulin, and plasma glycaemia and insulin during an oral glucose tolerance test. Risk factors for pre- and post-transplant diabetes were also studied. The diagnosis of diabetes was based on an OGTT. RESULTS: The proportion of patients with diabetes before transplant, and at month 6 and 12 after transplant were 70.9%, 48.8% and 39.2%, respectively. Compared to baseline, at month 6 the odds ratio of having diabetes was 0.39 (IC 95% [0.21, 0.73]) and at month 12 it was 0.26 (IC 95% [0.14, 0.50]). The composite insulin sensitivity index values at 6 and 12 months were 1.72 units higher (IC 95% [0.84, 2.58]) and 1.58 units higher (IC 95% [0.68, 2.44)] than baseline. A statistically significant association was found between high MELD values and high body mass index, and risk of pre-transplant diabetes (p=0.001 and p=0.033, respectively). Cirrhosis aetiology did not influence the risk of diabetes. CONCLUSIONS: In this study, we were able to ascertain that alterations in carbohydrate metabolism typical of advanced cirrhosis improve after liver transplant. This improvement is mainly due to an improvement in insulin resistance.