Outcomes of immunosuppression minimization and withdrawal early after liver transplantation

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149209/1/ajt15205.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149209/2/ajt15205_am.pd

Impact of Donor and Recipient Clinical Characteristics and Hepatic Histology on Steatosis/Fibrosis Following Liver Transplantation

BackgroundDeceased donor and recipient predictors of posttransplant steatosis/steatohepatitis and fibrosis are not well known. Our aim was to evaluate the prevalence and assess donor and recipient predictors of steatosis, steatohepatitis, and fibrosis in liver transplantation recipients.MethodsUsing the immune tolerance network A-WISH multicenter study (NCT00135694), donor and recipient demographic and clinical features were collected. Liver biopsies were taken from the donor liver at transplant, and from recipients per protocol and for-cause (ie, abnormal transaminases and to rule out rejection) and were interpreted by a central pathologist.ResultsOne hundred eighty-three paired donor/recipients liver biopsies at the time of transplant and posttransplant follow-up (median time 582 d; average time to last biopsies was 704 d [SD ± 402 d]) were analyzed. Donor steatosis did not influence recipient steatosis or fibrosis. Ten of 183 recipients had steatohepatitis on the last biopsy. Recipient body mass index at the time of liver biopsy was the most influential factor associated with posttransplant steatosis. Both donor and recipient metabolic syndrome features were not associated with graft steatosis. Untreated hepatitis C viral (HCV) infection was the most influential factor associated with the development of allograft fibrosis.ConclusionsIn a large experience evaluating paired donor and recipient characteristics, recipient body mass index at the time of liver biopsy was most significantly associated with posttransplant steatosis. Untreated HCV etiology influenced graft fibrosis. Thus relative to untreated HCV, hepatic fibrosis in those with steatosis/steatohepatitis is less common though long-term follow-up is needed to determine the course of posttransplant fibrosis. Emphasis on recipient weight control is essential

Using Phenology to Optimize Timing of Mowing and Grazing Treatments for Medusahead (Taeniatherum caput-medusae)

The invasive annual grass medusahead (Taeniatherum caput-medusae [L.] Nevski) poses a substantial threat to the health and function of rangelands across the western United States. On rangelands containing other desirable annual grasses, selective control of medusahead is difficult as this invasive species has traits similar to those of desired species. One key trait that differs between medusahead and other annual grasses is the rate and timing of phenological development. In this study we define management states for medusahead on the basis of the patterns of variation of forage palatability and susceptibility of seed production to defoliation over phenological stages. We integrate these management states with field observations to model the rates and timing of phenology-based management states to identify when targeted grazing or mowing treatments are most appropriate using Dirichlet regression and multistate modeling. While defoliation at any phenological stage from V3 (boot) to R8 (milk stage) was effective in reducing medusahead seed head production, clipping after anthesis almost eliminated seed production. However, the observed decline in crude protein at this point (11-8%) suggests that the transition from R4 (emergence of awns) to R5 (anthesis) is also the point at which medusahead becomes both unpalatable and not adequately nutritious to livestock. As a consequence there was a window of 10 to 15 days when 90% or more of medusahead reproductive tillers are susceptible to grazing but could also support nutritional needs of cattle and sheep to prevent avoidance in diet selection. In contrast, the window of opportunity for mowing, on average, extended for about 35 days. In a given year, the timing in which different medusahead populations entered each phenological stage varied at both the landscape and pasture scale, which creates both challenges and opportunities in using grazing animals and other defoliation mechanisms to control medusahead. © 2017 The Society for Range Management.The Rangeland Ecology & Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information