Highlights d Spatial proteogenomic single-cell atlas of healthy and obese murine and human liver d Validated flow cytometry and microscopy panels for all hepatic cells d LAMs are differentially located in the lean and obese liver d Evolutionary conserved BMP9/10-ALK1 axis is essential for KC development

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Portopulmonary hypertension (POPH), a complication of chronic liver disease, may be a contraindication to liver transplantation (LT) because of the elevated risk of peritransplant and posttransplant morbidity and mortality. Because POPH is frequently asymptomatic, screening with echocardiography is recommended. The only reliable technique, however, for diagnosing POPH is right heart catheterization (RHC). The aims of this study were to evaluate the current estimated systolic pulmonary artery pressure (sPAP) cutoff value of 30 mm Hg and to determine a better cutoff value. One hundred fifty-two patients underwent pretransplant echocardiography between January 2005 and December 2010. These echocardiographic results were compared with pulmonary artery pressures measured during the pretransplant workup or at the beginning of the transplantation procedure (both by catheterization). With a cutoff value of 30 mm Hg, 74 of the 152 patients met the criteria for POPH on echocardiography, although the diagnosis was confirmed in only 7 patients during catheterization; this resulted in a specificity of 54%. It would have been more accurate to use a cutoff value of 38 mm Hg, which had a maximal specificity of 82% and, at the same time, guaranteed a sensitivity and negative predictive value of 100%. With the incorporation of the presence or absence of right ventricular dilatation, the specificity even increased to 93% for this new cutoff value. In conclusion, the prevalence of POPH was 4.6% among LT candidates in this study. We can recommend that LT candidates with an sPAP > 38 mm Hg should be referred for RHC. With the cutoff value increased from 30 to 38 mm Hg, the number of patients undergoing invasive RHC during their evaluation could be safely reduced. Liver Transpl 19:602-610, 2013. V C 2013 AASLD.Received November 11, 2012; accepted February 27, 2013. See Editorial on Page 573Portopulmonary hypertension (POPH), the presence of pulmonary hypertension in association with portal hypertension, is a known complication of chronic liver disease.1-9 Prospective studies and case-control studies have documented that POPH occurs in approximately 5% to 6% of patients with advanced liver disease. 5 In patients with portal hypertension, the association with pulmonary hypertension is seen in 2% to 6%.10,11 The incidence of POPH in patients referred for liver transplantation (LT) is 4% to 6%. 12Abbreviations: CO, cardiac output; LT, liver transplantation; mPAP, mean pulmonary artery pressure; mRAP, mean right atrial pressure; NA, not applicable; ND, not determined; NS, not significant; PCWP, pulmonary capillary wedge pressure; POPH, portopulmonary hypertension; PVR, pulmonary vascular resistance; RHC, right heart catheterization; RVEDD, right ventricular end-diastolic diameter; sPAP, systolic pulmonary artery pressure; SVR, systemic vascular resistance; TPG, transpulmonary gradient.

percutaneous therapeutic interventions under X-ray control were performed in patients with exudative complications. Results: Sensitivity, specificity and diagnostic accuracy of ultrasound imaging were respectively 84.7%, 73.4% and 78.8%. Sensitivity, specificity and diagnostic efficiency of cytological and microbiological examination of our data were, respectively, 86.9%, 95.2% and 91.6%. 737 miniinvasive percutaneous interventions were hold totaly. The implementation of miniinvasive percutaneous interventions helped to stop the disease process and to avoid open surgical procedures in 91.7% of cases. Conclusion: Fine-needle diagnostic puncture is a highly informative method for diagnosis of the nature and details of tissue damage and pathological process phase. The timely refining ultrasound diagnosis of various clinical and morphological forms of acute pancreatitis combined with diagnostic fine-needle puncture conducting allows to approach differentiately to the implementation of miniinvasive percutaneous interventions and to justify a strategic position in the surgical treatment of destructive pancreatitis.

Despite all recent developments in surgical techniques during liver surgery, blood loss is still one of the main causes for postoperative morbidity and mortality. Other complications include bile leakage and fluid accumulation intraperitoneally. Fibrin sealants are able not only to enhance clot formation and wound healing but possibly work as a sealing device for postoperative leakage and fistula formation. In this overview the underlying mechanisms for these agents are discussed and several clinical data concerning liver surgery will be reported.

New-onset diabetes after transplantation (NODAT) is a frequent complication after liver transplantation and has a negative impact on both patient and graft survival. In analogy with the previous finding of an association between posttransplant hypomagnesemia and NODAT in renal transplant recipients, the relation between both pretransplant and posttransplant hypomagnesemia and NODAT was studied in liver transplant recipients (LTRs). One hundred sixty-nine adult LTRs (>18 years old) without diabetes who underwent transplantation between 2004 and 2009 were studied (mean age ¼ 52.11 6 12.6 years, proportion of LTRs who were male ¼ 67.5%, body mass index ¼ 25.5 6 4.4 kg/m 2 , proportion receiving tacrolimus ¼ 90.0%). NODAT was defined according to the American Diabetes Association criteria. The association of NODAT with both pretransplant and posttransplant serum magnesium (Mg) was examined. Overall, 52 of 169 patients (30.8%) developed NODAT, and 57.7% of these (30 patients) were treated with antidiabetic drugs. Both pretransplant Mg levels and Mg levels in the first month after transplantation were lower in patients developing NODAT (P ¼ 0.008 and P ¼ 0.001, respectively). A multivariate regression model (adjusted for weight, pretransplant glucose levels, hyperglycemia in the first week after transplantation, gender, hepatitis C, and corticosteroid dosing) demonstrated both pretransplant Mg levels (hazard ratio ¼ 0.844 per 0.1 mg/dL increase, 95% confidence interval ¼ 0.764-0.932, P ¼ 0.001) and posttransplant Mg levels (hazard ratio ¼ 0.659, 95% confidence interval ¼ 0.518-0.838, P ¼ 0.001) to be independent predictors of NODAT together with age, biopsy-proven acute rejection, and cytomegalovirus (CMV) infection in the first year after transplantation. In conclusion, pretransplant hypomagnesemia and early posttransplant hypomagnesemia are independent predictors of new-onset diabetes after liver transplantation. New-onset diabetes after transplantation (NODAT) is a frequent complication after liver transplantation and develops in 10% to 30% of all patients according to the majority of studies [1][2][3] ; another 10% to 30% of patients already have diabetes before transplantation. 4 NODAT has a negative impact on both graft and patient survival and is related to chronic rejection and hepatic artery thrombosis. A recent study by our group has demonstrated that posttransplant hypomagnesemia is an independent risk factor for NODAT in the renal transplant population.6 Hypomagnesemia in renal transplant recipients (RTRs) is more common with tacrolimus-based immunosuppressive regimens versus cyclosporine-based ones 7 but overall seems more connected to the use of calcineurin inhibitors (CNIs).8 It is due mainly to

Portopulmonary hypertension (POPH) is a part of group 1 pulmonary hypertension (pulmonary hypertension associated with portal hypertension). Liver transplantation (LTx) may be curative, but is usually restricted to patients with mild-to-moderate POPH. The presence of severe POPH may be a contraindication to transplantation because of the elevated risk of peritransplantation and post-transplantation morbidity and mortality. This report describes a series of seven patients with onset of moderate (two patients) or severe (five patients) POPH before LTx, of whom six were treated with oral vasodilator therapy for POPH. Although previous studies recommend aggressive parenteral prostacyclin therapy (epoprostenol), we describe the opportunity to treat cases of severe POPH with an oral phosphodiesterase type 5 inhibitor (sildenafil) and/or an endothelin receptor antagonist (bosentan/ambrisentan) as a bridge to successful LTx in selected patients.

Although, according to the available data, the gastric banding operation with the Swedish band meets the criteria of a low-risk laparoscopic alternative treatment of morbid obesity, the radiologic appearances of various complications may be seen on the images of patients who have undergone the procedure. The radiologist plays a key role in the early detection of those complications and treatment of specific abnormalities.