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Improvements in the management of patients undergoing liver transplantation (LT) have resulted in a significant increase in survival in recent years. Cardiac disease is now the leading cause of early mortality, and the stress of major surgery, hemodynamic shifts, and the possibilities of hemorrhage or reperfusion syndrome require the recipient to have good baseline cardiac function. The prevalence of coronary artery disease (CAD) is increasing in LT candidates, especially in those with nonalcoholic fatty liver disease. In assessing LT recipients, we suggest a management paradigm of "quadruple assessment" to include (1) history, examination, and electrocardiogram; (2) transthoracic echocardiogram; (3) functional testing; and (4) where appropriate, direct assessment of CAD. The added value of functional testing, such as cardiopulmonary exercise testing, has been shown to be able to predict posttransplant complications independently of the presence of CV disease. This approach gives the assessment team the greatest chance of detecting and preventing complications related to CAD. Liver Transplantation 23 386-395 2017 AASLD.

ObjectiveIn order to explain the increased susceptibility to serious infection in alcoholic hepatitis, we evaluated monocyte phagocytosis, aberrations of associated signalling pathways and their reversibility, and whether phagocytic defects could predict subsequent infection.DesignMonocytes were identified from blood samples of 42 patients with severe alcoholic hepatitis using monoclonal antibody to CD14. Phagocytosis and monocyte oxidative burst (MOB) were measured ex vivo using flow cytometry, luminometry and bacterial killing assays. Defects were related to the subsequent development of infection. Intracellular signalling pathways were investigated using western blotting and PCR. Interferon-γ (IFN-γ) was evaluated for its therapeutic potential in reversing phagocytic defects. Paired longitudinal samples were used to evaluate the effect of in vivo prednisolone therapy.ResultsMOB, production of superoxide and bacterial killing in response to Escherichia coli were markedly impaired in patients with alcoholic hepatitis. Pretreatment MOB predicted development of infection within two weeks with sensitivity and specificity that were superior to available clinical markers. Accordingly, defective MOB was associated with death at 28 and 90 days. Expression of the gp91phox subunit of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase was reduced in patients with alcoholic hepatitis demonstrating defective MOB. Monocytes were refractory to IFN-γ stimulation and showed high levels of a negative regulator of cytokine signalling, suppressor of cytokine signalling-1. MOB was unaffected by 7 days in vivo prednisolone therapy.ConclusionsMonocyte oxidative burst and bacterial killing is impaired in alcoholic hepatitis while bacterial uptake by phagocytosis is preserved. Defective MOB is associated with reduced expression of NADPH oxidase in these patients and predicts the development of infection and death.

The knowledge of yields and properties of soot from combustion of hydrocarbon fuels is crucial for accurate evaluation of the impacts of primary aerosols on air quality and climate. This study presents measurements of soot generated from combustion of propane in a shock tube, using independently adjustable fuel equivalence ratio (φ), temperature, and pressure. The characterization of soot yields inside the shock tube by in situ laser extinction is complemented with a set of comprehensive measurements of soot transferred into a fluoropolymer chamber, including particle size distributions, elemental carbon (EC) mass fraction, effective density, mass fractal dimension (Dfm), dynamic shape factor (χ ), and optical properties. The properties of soot particles and the soot yield are sensitive to combustion conditions and the duration of the combustion experiment. High-temperature combustion with φ = 2.5 produces small fractal (Dfm = 2) soot particles composed mainly of EC (up to 90%), at a low mass yield. Particles from lower temperature combustion contain a significant fraction of organic material (∼50%). Using rich fuel mixtures (φ = 4.0 and 8.0) significantly increases particle size and soot mass yield. At lower temperatures, compact (Dfm = 3) and nearly spherical (χ = 1.1) aggregates with high organic content are formed, whereas at higher temperatures, the particles are fractal and closely resemble those obtained using φ = 2.5. Single scattering albedo (SSA) varies from 0.15 for fractal particles to 0.75 for compact particles. For soot generated at high equivalence ratios, SSA can be used as a proxy for particle morphology and EC content.