Recipients of solitary liver and kidney transplants are living longer, and this increases their risk of long‐term complications such as recurrent hepatitis C virus (HCV) and drug‐induced nephrotoxicity. These complications may require retransplantation. Since the adoption of the Model for End‐Stage Liver Disease, the number of simultaneous liver‐kidney transplantation (SLK) procedures has increased. However, there are no standardized criteria for organ allocation to SLK candidates. The aims of this study were to retrospectively compare recipient and graft survival with liver transplantation alone (LTA), SLK, kidney after liver transplantation (KALT), and liver after kidney transplantation (LAKT) and to identify independent risk factors affecting recipient and graft survival. The United Network for Organ Sharing/Organ Procurement and Transplantation Network database (1988‐2007) was queried for adult LTA (66,026), SLK (2327), KALT (1738), and LAKT procedures (242). After adjustments for potential confounding demographic and clinical variables, there was no difference in recipient mortality rates with LTA and SLK (P = 0.02). However, there was a 15% decreased risk of graft loss with SLK versus LTA (hazard ratio = 0.85, P < 0.001). The recipient and graft survival rates with SLK were higher than the rates with both KALT (P <0.001 and P <0.001) and LAKT (P = 0.003 and P < 0.001). The following were all identified as independent negative predictors of recipient mortality and graft loss: recipient age ≥ 65 years, male sex, black race, HCV/diabetes mellitus status, donor age ≥ 60 years, serum creatinine level ≥2.0 mg/dL, cold ischemia time > 12 hours, and warm ischemia time > 60 minutes. Although the recent increase in the number of SLK procedures performed each year has effectively decreased the number of potential donor kidneys available to patients with end‐stage renal disease (ESRD) awaiting kidney transplantation, SLK in patients with end‐stage liver disease and ESRD is justified because of the lower risk of graft loss with SLK versus LTA as well as the superior recipient and graft survival with SLK versus serial liver‐kidney transplantation. Liver Transpl, 2012. © 2012 AASLD.

Background Deficiencies in vitamins A, D and E have been linked to night blindness, bone health, and post-liver transplant reperfusion injury. Aims To determine the prevalence and predictive factors of fat soluble vitamin deficiencies in liver transplantation candidates. Methods We reviewed medical records of liver transplantation candidates at our center from 1/2008–9/2011. Etiology of cirrhosis, MELD scores, Child Pugh class, BMI, vitamin A, vitamin E, and vitamin 25-OH-D levels were recorded. Patients were excluded for incomplete laboratory data, short gut syndrome, celiac disease, pancreatic insufficiency, or prior liver transplantation. Results Sixty three patients were included. The most common etiologies of liver disease were alcohol (23), hepatitis C (19), and NASH (5). Vitamin A and D deficiency was noted in 69.8% and 80.9%, respectively. Only 3.2% of patients were vitamin E deficient. There were no documented cases of night blindness. Of 55 patients with bone density measurements, 25 had osteopenia and 10 had osteoporosis. Four patients had vertebral fractures. There was one case of post-transplant reperfusion injury in a patient with vitamin E deficiency. In a multivariate analysis, there were no statistically significant predictors for vitamin D deficiency. Child Pugh class (OR=6.84 {1.52–30.86};p = 0.012), elevated total bilirubin (OR=44.23{5.02–389.41}; p < .001), and elevated BMI (OR=1.17{1.00–1.36};p = 0.045) were found to be predictors of vitamin A deficiency. Conclusions The majority of liver disease patients evaluated for liver transplantation at our center had vitamin A and D deficiency. Presence or absence of cholestatic liver disease did not predict the deficiency, whereas Child Pugh class, bilirubin level, and elevated BMI predicted vitamin A deficiency.

ABSTRACT. A multi-l ayered snow model, including most physical processes governing the evoluti on of snow packs, has been co upl ed to a globa l circul ati on model (GCM ) to improve the represe nta tion of snow cover in cl im a te simulations. The snow model (Crocus) includes o ri gin al feat ures to simul ate th e evolu tion of snowpaek layer ing that all ows a rea li stic calculation of snow albcdo as a function of the type and size of th e crys ta ls of the surface laye r. The coupling schcm e is based on a sy nchronous run of the GCM a nd of th e snow model with a n excha nge of the surface flu xes at eve ry tim e-step. It was tested in a fiv e-year run at a T4·2 resolution. The impact on th e atmosphere was important over most snow-covere d region s a nd th e snowpacks simul a ted in the differe nt regions present a layering that is realistic and very variable in co nnection with thc climate. The simul ated snow cover compares sati sfactorily with th e present snow clim atology.

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ABSTRACT. M eas urements of sensible-and latent-h eat fluxes under stable conditi ons a re rare. In order to obtain indirec t m eas urem ents of wrbulent fluxes, meteorolog ical data measured at the Col de Porte laboratory (1320 m a.s. l, France ) under very stabl e co nditions (cold, clear night with low wind ) a re used. Th e radi ative f1uxes are meas ured, th e conduction within the snowpack is calcu lated using the snow model Crocus and the turbulent fluxes are d etermined as a residual term of the surface-energy balance equation. These data were used to fit a new parameterization of the turbulent f1ux es for th e snow model. The turbu lent fluxes are increased as compared to the theor y. Crocus wa s also applied to th e data from the LEADEX92 experiment and the turbulent fluxes calcul a ted by the m odel were compa red to th e fluxes meas ured using sonic anemometers/thermometers on the site.