BACKGROUNDTransplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion... Show moreBACKGROUNDTransplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.METHODSIn this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.RESULTSA total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P=0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.CONCLUSIONSHypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage. Show less
For conservation management of grassland ecosystems, an important question is under which conditions large grazers induce compositional and structural variation in plant communities, which is a... Show moreFor conservation management of grassland ecosystems, an important question is under which conditions large grazers induce compositional and structural variation in plant communities, which is a prerequisite for high biodiversity. Here we used two long-term projects on the mainland salt marshes of the Wadden Sea to test the hypothesis that long-term grazing management with different stocking densities results in plant communities with distinctively different plant species composition and vegetation structure. The two projects took place on a low clayey and a high sandy salt marsh with different stocking densities of sheep: 0, 1.5, 3.5, 4.5 and the initially 10 sheep ha(-1), where measurements were collected 11, 15, 19 and 23 years after the start of the project. Moreover, grazers affect abiotic conditions by reducing soil-redox potential and surface elevation, thereby driving composition and structure of salt-marsh vegetation. On the low salt marsh, a continued high stocking density (10 sheep ha(-1)) resulted in succession from the early-successional Puccinellia maritima community to the late-successional Atriplex portulacoides community. On the high salt marsh, the early-successional Festuca rubra community was maintained under all stocking densities. Cessation of grazing resulted in succession to the Elytrigia atherica community in both salt-marsh types. Intermediate stocking densities (1.5, 3 or 4.5 sheep ha(-1)) resulted in a mosaic of tall vegetation and patches of lawn, i.e. short-grazed vegetation, where Puccinellia maritima lawn occurred interspersed with patches of the Festuca rubra and tall Elytrigia atherica communities in both salt-marsh types. Effects of grazers were influenced by the presence of watering points near the sea wall. To conclude, our results show how joint interactions between grazers and abiotic conditions drive vegetation diversity and heterogeneity, with implications for ecosystem functions and services such as wildlife biodiversity and coastal protection. Show less
Rijn, R. van; Berg, A.P. van den; Erdmann, J.I.; Heaton, N.; Hoek, B. van; Jonge, J. de; ... ; Porte, R.J. 2019
