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Competing Interests: The authors report no declarations of interest.

Appropriate metrics for performance analysis is an active topic of debate within the transplant community. This study explores current proposals on metric expansion as well as potential metrics and prospective collaborations that have not received widespread discussion within the transplant community. The premature introduction of additional, nonvalidated metrics risks behaviors that may undermine donor utilization and patient access to transplantation., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The Scientific Registry of Transplant Recipients (SRTR) has released a 5-tier performance ranking system based upon results of deceased-donor and living-donor liver transplantation., Materials and Methods: An analysis of Spring 2017 SRTR Program Specific Reports for outcomes of adult living-donor and deceased-donor liver transplantation., Results: Utilizing the current SRTR performance algorithm, living-donor liver transplant results may disproportionately affect transplant center performance ranking., Conclusion: Improvements in SRTR performance ranking including transparency in outcomes calculation, a calculating tool for transplant centers, and the potential reporting of living-donor outcomes as a separate report are necessary., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Hepatic function and pulmonary function are interrelated with failure of one organ system affecting the other. With improved therapies, patients with concomitant hepatic and pulmonary failure increasingly enjoy a good quality of life and life expectancy. Therefore, the prevalence of such patients is increasing with more presenting for both emergent and elective surgical procedures. Hypoxemia requires a thorough evaluation in patients with end-stage liver disease. The most common etiologies respond to appropriate therapy. Portopulmonary hypertension and hepatopulmonary syndrome are associated with increased perioperative morbidity and mortality. It is incumbent on the anesthesiologist to understand the physiology of liver failure and its early effect on pulmonary function to ensure a successful outcome., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Critical care of the general surgical patient requires synthesis of the patient's physiology, intraoperative events, and preexisting comorbidities. Evaluating an abdominal solid-organ transplant recipient after surgery adds a new dimension to clinical decisions because the transplanted allograft has undergone its own physiologic challenges and now must adapt to a new environment. This donor-recipient interaction forms the foundation for assessment of early allograft function (EAF). The intensivist must accurately assess and support EAF within the context of the recipient's current physiology and preexisting comorbidities. Optimizing EAF is essential because allograft failure is a significant predictor of recipient morbidity and mortality., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Clostridium perfringens sepsis following orthotopic liver transplantation (OLT) is a rare but reported complication that historically results in mortality or emergent retransplantation (ReTx). Complications from C. perfringens emphysematous gastritis have contributed to the death of a healthy live liver donor as well. Herein, we describe the first documented survivor of C. perfringens sepsis following OLT managed without laparotomy or emergent ReTx.

Transplantation-mediated alloimmune thrombocytopenia (TMAT) is donor-derived thrombocytopenia following solid-organ transplantation. To date, no clear consensus on the appropriateness of organ utilization from cadaver donors with a history of idiopathic thrombocytopenia purpura (ITP) has emerged. Herein is reported a devastating case of TMAT following liver transplantation utilizing an allograft from a donor with ITP that resulted in allograft failure. The literature is reviewed in this context to propose preliminary guidelines regarding utilization of allografts from cadaver donors with a history of ITP.

Hepatic injury in cardiac surgery is a rare complication but is associated with significant morbidity and mortality. A high index of suspicion postoperatively will lead to earlier treatment directed at eliminating or minimizing ongoing hepatic injury while preventing additional metabolic stress from ischemia, hemorrhage, or sepsis. The evidence-basis for perioperative renal risk factors remains hampered by the inconsistent definitions for renal injury. Although acute kidney injury (as defined by the Risk, Injury, Failure, Loss, End-stage criteria) has become accepted, it does not address pathogenesis and bears little relevance to cardiac surgery. Although acute renal failure requiring renal replacement therapy after cardiac surgery is rare, it has a devastating impact on morbidity and mortality, and further studies on protective strategies are essential.

Objective: To elicit donor opinions on liver living donation through use of a survey that protected the anonymity of the respondent and to assay long-term (follow-up > 1 year) donor health by a widely recognized instrument for health assessment., Summary Background Data: Living-donor liver transplantation is an accepted technique for children that has recently been extended to adults. Limited donor outcomes data suggest favorable results, but no outcomes data have been reported using an instrument that elicits an anonymous response from the donor or employs a widely recognized health survey., Methods: Forty-one living-donors between June 1992 and June 1999 were identified and included in this study, regardless of specific donor or recipient outcome. Each donor received a 68-question survey and a standard McMaster Health Index., Results: Survey response was 80%. All donors were satisfied with the information provided to them before donation. Eighty-eight percent of donors initially learned of living donation only after their child had been diagnosed with liver disease: 44% through the transplant center, 40% by popular media, 12% by their pediatrician, and 4% by their primary care physician. Physical symptoms, including pain and the surgical wound, were recurrent items of concern. Perception of time to "complete" recovery were less than 3 months (74%), 3 to 6 months (16%), and more than 6 months (10%). Donors' return to physical activities was shown by above-mean McMaster physical scores; scores for social and emotional health were not different from population data. There were no reported changes in sexual function or menstruation after donation, and five of six donors procreated., Conclusions: Donors overwhelmingly endorsed living donation regardless of recipient outcome or the occurrence of a complication. Eighty-nine percent advocated "increased" application of living donation beyond "emergency situations," and no donor responded that living donation should be abandoned or that he or she felt "forced" to donate.

Copper levels of nearly 500 mg l(-1) were measured in aqueous extracts of soil and sediment samples from the lowlands of Antofagasta. Arsenic levels of up to 183 mg l(-1) were found in river sediments, and 27.5 mg l(-1) arsenic was found at the location of a dam where potable water is extracted. This indicates that the arsenic contamination of water supplies reported recently for the pre-Andes may be a widespread problem throughout the region. Copper contamination from smelting activities also provides cause for concern as elevated levels were found in aqueous extracts of soil up to 20 km away from a smelter. This study went beyond traditional chemical analysis by assessing the potential benefits of using microbial biosensors as an alternative to determination of chemical speciation, to provide an environmentally relevant interpretation of soil/sediment residue levels. This approach is simple to use and enables a rapid, low cost assessment of pollutant bioavailability. It may, therefore, be of use for further investigations in the region and beyond.

Longitudinal split and subluxation of the peroneus brevis tendon have been reported in surgery literature, but few publications report on longitudinal tears of the peroneus longus tendon. The most likely proposed mechanism is a mechanical one. This report discusses the ultrasonographic appearance of peroneus longus and peroneus brevis tendon splits and the mechanism of injury.