Donor derived Ig A nephropathy is generally considered to follow a transient benign course. We report a case of donor derived IgA nephropathy causing severe and persistent nephrotic syndrome after kidney transplantation.
Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous spectrum of lymphoproliferative disorders that can develop in the setting of immunosuppression following transplant. In this report, we highlight the first presentation of recurrent EBV-negative monomorphic PTLD in sequential liver allografts.
Lung transplantation remains a critical therapeutic option for patients with end-stage pulmonary diseases, yet postoperative management continues to face significant challenges including immune rejection, infections, and graft dysfunction. Traditional immunosuppressive regimens, while effective, are often associated with adverse effects and complications, prompting the search for adjunctive therapies with improved safety profiles. In recent years, natural compounds have gained increasing attention due to their multi-target regulatory properties and relatively low toxicity, positioning them as promising candidates for post-lung transplantation adjuvant treatment. This review comprehensively summarizes the latest research progress on the application of natural compounds in modulating immune responses, reducing inflammation, and preventing fibrosis after lung transplantation. We explore the underlying molecular mechanisms through which these compounds exert their effects, such as modulation of immune cell activity, cytokine regulation, and inhibition of fibrotic pathways. Additionally, the review discusses the current challenges and future clinical prospects of integrating natural compounds into comprehensive post-transplant care, highlighting their potential to enhance graft survival and patient outcomes. By providing an updated and critical overview, this article aims to offer new insights and strategic directions for improving postoperative management in lung transplant recipients through the use of natural bioactive agents.
Introduction Kidney transplantation is the gold standard treatment for end-stage kidney failure, and most organs are derived from brain-dead (BD) organ donors. BD triggers a cascade of physiological disturbances that may compromise renal function and frequently results in diabetes insipidus (DI). This condition is associated with negative transplant outcomes, such as impaired graft survival and acute rejection. Methods We conducted a single-center retrospective cohort study (2018–2023) involving 1015 BD organ donors. Kidney function was assessed by measuring serum urea and creatinine levels. Serum sodium levels, DI treatment, and reasons for kidney discard were also analyzed. These parameters were evaluated at two critical time points: upon initial hospital admission for the primary neurological injury and before organ retrieval (pre-retrieval). Results In our cohort, most kidneys were transplanted (74.3%), while 25.7% were discarded. Organ donors showed a significant worsening of laboratory markers of kidney function between admission and pre-retrieval, with a mean paired increase in urea of 39.96 mg/dL (95% CI: 38.14–41.78; p < 0.001) and creatinine of 1.11 mg/dL (95% CI: 0.97–1.25; p < 0.001). Hypernatremia also worsened, with a mean increase in serum sodium of 11.4 mEq/L (95% CI: 10.6–12.2; p < 0.001). Moreover, significantly lower pre-retrieval serum sodium levels were observed in donors who received treatment for DI compared to those who did not (p < 0.001). Discarded kidneys were more frequently associated with morphological abnormalities, followed by infection and hepatitis C. Conclusion In a 6-year single-center cohort of BD donors, pre-retrieval laboratory markers of kidney function and serum sodium levels were worse than at admission; DI correction was associated with lower pre-retrieval sodium. These findings support rigorous donor-management protocols, but causal effects cannot be inferred from this retrospective analysis.
Introduction Skin cancer is the most common malignancy in kidney transplant recipients (KTRs), with a higher aggressiveness due to prolonged immunosuppression. Optimizing immunosuppressive regimens may reduce risk while preserving graft function. This study aimed to determine the long-term incidence and characteristics of skin cancer in KTRs receiving steroid-free, reduced-dose calcineurin inhibitor therapy. Methods We conducted a retrospective cohort study including all KTRs transplanted between 2008 and 2018 at Colombiana de Trasplantes. Demographic, clinical, and histopathological data were extracted from institutional records. Patients were stratified by the occurrence of skin cancer. Statistical analyses included descriptive and comparative estimates, Kaplan–Meier survival curves, and log-rank tests. Results A total of 1660 KTRs were analyzed, with 34 developing skin cancer, yielding a cumulative incidence of 2.05%. Patients with skin cancer were significantly older at transplantation than those without (52.5 ± 10.7 vs. 43.2 ± 13.3 years, p < 0.001). No other baseline variables differed between groups. The cumulative risk of skin cancer increased progressively with follow-up: 7.1% at 5 years and 17.8% at 10 years post-transplant. Conclusion This single-center study is the first in Colombia to describe long-term skin cancer outcomes in kidney transplant recipients (KTRs) under steroid-free, reduced-dose immunosuppression. The incidence observed in this cohort was lower than that reported in international series, which may reflect a potential protective effect of optimized immunosuppressive regimens; however, the possibility of underdiagnosis cannot be excluded. These findings highlight the need for sustained dermatologic surveillance beyond 5 years post-transplant and support strategies to optimize immunosuppressive regimens.
Background Calcineurin Inhibitors (CNI) and mammalian target of rapamycin inhibitors (mTORi) have been traditionally used as immunosuppressants to prevent rejection in kidney transplant recipients, but they are often associated with undesirable renal and metabolic adverse effects. Belatacept, a selective T-cell co-stimulation blocker, does not have undesirable effects. However, there is no data on using belatacept in combination with low dose calcineurin inhibitors (CNIs)/sirolimus. At our institution, patients are switched to this combination regimen if they have slow or delayed graft function, complications related to CNIs or graft rejection while on CNIs or sirolimus. Methods We conducted a retrospective study evaluating all patients >18 years of age at Indiana University Hospital who had a kidney transplant and were switched from tacrolimus, sirolimus or cyclosporine to a combination of belatacept and lower dose CNI/sirolimus. A response to the addition of belatacept was defined as >10% change in the eGFR per year from baseline (pre-belatacept values) over 2 years. Logistic regression models were performed. Results Seventy-nine subjects were included in the study with a mean age of 52.3 ± 14.7 years and followed up to 2.01 years (Median [IQR] = 1.02 [0.93, 1.99] years) post belatacept use. Response was observed in 54% of patients with improved eGFR by 6 months (p = 0.003) and sustained improvement at 2 years with an eGFR of 49.1 ± 19.5 vs. 35.3 ± 11.4 (p = 0.04; n = 13 each) in non-responders. The final multiple logistic regression model found having a retransplant (OR=5.81; 95% CI: 1.67–20.22; p = 0.006), log of higher level of proteinuria (OR=1.74; 95% CI: 1.08–2.78; p = 0.022), longer dialysis vintage before transplantation (OR=1.01; 95% CI: 1.00–1.03; p = 0.048) and history of graft rejection prior to the conversion to this regimen(OR=11.36;95% CI:1.84–70.07;p = 0.009) were all significantly associated with non-response. Conclusion Belatacept in combination with low dose conventional immunosuppression appears to be a favorable option in patients with slow/delayed graft function or intolerance to conventional drugs at their usual therapeutic levels.
Liver transplantation (LT) can significantly improve survival and quality of life for patients with end-stage liver disease however, post-LT outcomes are impacted by environmental factors beyond medical care. This review explores the impact of Social Determinants of Health (SDoH) on post-LT outcomes by using the five pillars of SDOH derived from the Healthy People 2030 framework: education access and quality, economic stability, healthcare access, neighborhood and build environment, and social and community context. The existing literature highlights that low health literacy, socioeconomic disparities, insurance type, and geographic disparities contribute to higher rates of mortality, graft loss and non-adherence to immunosuppression. Geographic areas located in food deserts, limited access to primary care physicians, physical therapy and mental health support can further impact graft survival. Addressing these factors through improved education, equitable healthcare access and sustained insurance coverage is essential for achieving optimal post-LT outcomes.
Background: The virtual crossmatch (VXM) is a novel tool used to identify donor-specific antibodies (DSA) in kidney transplantation without requiring physical donor samples, reducing cold ischemia time (CIT). This study evaluates the specificity of VXM compared to the prospective crossmatch (PXM)/flow cytometric crossmatch (FCXM) in kidney transplant recipients with varying levels of cumulative panel reactive antibodies (cPRA) at a Canadian tertiary care institution. Methods: We conducted a retrospective analysis of all VXMs performed at the London Health Sciences Centre, Ontario from 2020 to 2023. Data included patient demographics, cPRA levels, FCXM results, and DSA titers. Patients were categorized by cPRA levels (0–20, 21–40, 41–60, 61–80, and 81–100%), and the Z-test was used to compare the proportion of positive crossmatches across these groups. A p-value of <0.05 was considered statistically significant. Results: Of 955 patients reviewed, 62% had a cPRA ≤20%. Positive PXM rates were not significantly different in the cPRA 0–20, 21–40, and 41–60% groups (p > 0.05). However, significantly higher positive PXM rates were observed in the 61–80% and 81–100% groups (p = 0.0001 and p = 0.00013, respectively). Positive DSA titers were statistically significant only in the cPRA 81–100% group (24%, p = 0.0002). VXM demonstrated high specificity for predicting negative PXM outcomes in cPRA ≤60% but was less predictive for highly sensitized patients (cPRA >60%). Conclusions: The VXM reliably predicts negative FCXM outcomes in patients with cPRA ≤60%, supporting its use in this population to streamline workflows and reduce CIT. For cPRA >60%, confirmatory FCXM remains necessary prior to transplantation due to the persistent likelihood of positive crossmatches, likely driven by non-HLA antibodies and allele-specific DSAs. Tailored protocols and technological advancements are essential to optimize crossmatch processes.
Background: Solid organ transplants (SOT) such as those of the lungs, heart, kidneys, pancreas, and liver are associated with physical impairments and functional limitations. Rehabilitation is a key component of care both pre- and post-surgery. Inspiratory muscle training (IMT) can be used to strengthen the respiratory muscles and may have significant effects on clinical outcomes and healthcare utilization in SOT candidates and recipients. Objectives: This scoping review aims to determine how IMT is used in SOT candidates and recipients by: 1) identifying which populations have been considered for IMT, 2) describing the IMT protocols used, and 3) examining the impact of IMT on clinical outcomes and healthcare utilization. Methods: A scoping review was conducted following the framework outlined by Arksey & O'Malley. A comprehensive search was performed in MEDLINE, EMBASE, and CINAHL. Articles were screened based on inclusion and exclusion criteria by two investigators. Data were extracted and reported to address the research objectives. Results: Fourteen studies targeting heart, lung, liver, kidney, and heart-lung transplant candidates or recipients evaluated IMT using different intensity, duration, and devices. Most studies focused on heart and lung transplant. Outcomes such as inspiratory muscle pressure, dyspnea, exercise capacity, and quality of life were assessed. IMT demonstrated improvements in respiratory strength, symptoms, and physical function across organ groups. Conclusion: IMT shows promise in improving clinical outcomes for SOT candidates and recipients. However, variability in protocols highlights the need for further research to define optimal strategies and assess long-term impacts on healthcare utilization.
Background: The relationship between pre-transplant body mass index (BMI) and post-transplant outcomes remains a topic of interest in liver transplantation. This study aimed to investigate the association between pre-transplant BMI categories and the incidence of infections and graft rejection among liver transplant recipients. Methods: The data for this study were obtained from a single-center LT database, consisting of 479 patients with ages >18 who underwent their first liver transplant during the period from May 2013 to September 2022. The patients were categorized into four groups based on their pre-transplant BMI: underweight (BMI < 18.5 kg/m²), normal weight (BMI from 18.5 to 24.9 kg/m²), overweight (BMI from 25 to 29.9 kg/m²), and obese (BMI ≥ 30 kg/m²). Results: Out of the total 479 patients included in the study, 13.4% and 11.7% experienced infectious complications and graft rejection following their liver transplant, respectively. Obesity was observed in 18.2% of patients and 6.5% were classified as underweight. Although the underweight group exhibited the highest rates of complications, no statistically significant differences were found among the BMI categories (P = 0.152 for infections; P = 0.072 for graft rejection), even after adjusting for confounders such as age and sex. Conclusions: In this study, pre-transplant BMI was not an independent predictor of post-transplant infections or graft rejection. While the underweight group displayed higher rates of infections and graft rejection, these differences were not statistically significant. Further research is needed to explore the complex mechanisms underlying these associations and to identify additional factors influencing post-transplant success.
Approximately half of all patients with colorectal cancer develop liver metastases over the course of their disease. While 20-30% of patients with colorectal liver metastases (CRLM) are potential candidates for curative hepatic resection, those with unresectable CRLM (uCRLM) have historically been limited to systemic chemotherapy or best supportive care. Recent evidence from the randomized controlled TransMet trial has demonstrated that orthotopic liver transplantation in carefully selected patients with uCRLM results in an 8-fold higher 5-year survival compared with chemotherapy only (73% versus 9%). When patient selection is further refined using tumor biology characteristics and response to chemotherapy as key selection criteria, encouraging 5-year survival rates ranging from 50-83% after LT have been reported. Although post-transplant tumor recurrence remains a major clinical concern, recurrent disease most commonly manifests as pulmonary metastases are frequently amenable to effective local or systemic treatment. Growing clinical evidence indicates that LT for uCRLM is emerging as a viable therapeutic strategy for highly selected patients lacking otherwise curative options. Nevertheless, the field urgently requires standardized selection protocols and clear guidance on how such transplant candidates should be prioritized within national organ allocation systems.
Objective: Post-transplant lymphoproliferative disorder (PTLD) is a well-documented complication in patients undergoing solid organ transplantation, with varying clinical presentations and progression. Tumor lysis syndrome (TLS), although typically associated with hematologic malignancies, can occur in PTLD under rare circumstances, often triggered by cytotoxic therapies. Methods: Here, we present a female in her late 50’s with a history of kidney transplantation complicated by PTLD who developed severe TLS following a temporary cessation of immunosuppressive therapy. Results: Despite aggressive management, the patient deteriorated rapidly, culminating in respiratory failure, disseminated intravascular coagulation (DIC), and death. Conclusion: This case highlights the unusual presentation, rapid progression, and catastrophic outcome of TLS in the context of PTLD without cytotoxic therapy, underlining the challenges in managing these patients. Early recognition and prompt management of TLS are crucial, especially in transplant recipients where clinical manifestations may be atypical.
Background: Engraftment is a determining factor for hospital discharge following autologous hematopoietic stem cell transplant (auto-HSCT). Delays in engraftment can lead to a longer hospital length of stay (LOS), infection, and higher financial costs. In an effort to decrease the time to engraftment, Intermountain Health’s Blood and Marrow Transplant Program modified the start time of granulocyte colony-stimulating factor (GCSF) initiation from Day +6 to Day +1. Objective: This study is a post-implementation retrospective review to determine if this practice change affects engraftment, hospital LOS, engraftment syndrome (ES) occurrence, and overall survival (OS). Study Design: The review was conducted among multiple myeloma and plasma cell disorder patients 18 years or older who received melphalan-based auto-HSCT at LDS Hospital. Comparison groups are those that received G-CSF on Day +6 after transplant (control) compared to Day +1 (intervention). Data was obtained via chart review and from preexisting program databases. Time to engraftment was measured as days from stem cell infusion until neutrophil engraftment, defined as the last of three consecutive days with an absolute neutrophil count (ANC) of 0.5 × 108/L or higher. As the primary outcome, time to engraftment was analyzed via a statistical t-test. Patients with suspected ES were identified by both the administration of steroids beyond transplant Day 0 and through chart documentation of ES. Lastly, 1-year OS post-transplant was evaluated. Differences in time to engraftment, hospital LOS, rate of ES, OS, and cost were compared between groups with both descriptive and inferential statistics. Confounding factors, including clinically significant baseline characteristics, were analyzed through multivariate regression analysis. Results: Between February 1, 2017, to October 24, 2022, 137 patients underwent melphalanbased auto-HSCT, with 129 patients included in the final analysis. At an average age of 62 years, the majority of patients were male, Caucasian, with multiple myeloma in CIBMTR stage of very good partial response (VGPR) and previous bortezomib, lenalidomide, and dexamethasone (VRd) induction therapy. Neutrophil engraftment was faster in the early administration group compared to delayed administration by approximately 1 day (95% CI -1.47 ̶ -0.79); p < 0.001). Median hospital LOS was also shorter with early G-CSF administration by 1 day (95% CI -3 ̶ -1, p < 0.001). There was no statistically significant difference between groups in ES occurrence or in OS at 1 year. Utilization of empiric antibiotics were similar, with shorter duration in the early administration group (difference 3.1 days). Finally, facility cost per patient transplant stay was lower with Day +1 G-CSF administration. Conclusion: Day +1 G-CSF administration has similar safety and efficacy to Day +6 G-CSF administration in patients receiving melphalan-based auto-HSCT. In fact, Day +1 administration may have improved efficacy outcomes, with 1 day shorter time to engraftment and hospital LOS.
Background In liver cirrhosis patients with high serum bilirubin, serves as a marker of poor liver function and prognosis. However, bilirubin exhibits anti-inflammatory and antioxidant effects, resulting in protective role in renal function. The current study therefore, studied the relationship between high bilirubin levels and chronic kidney disease (CKD) in liver cirrhosis patients and compares it to liver transplant recipients to better understand bilirubin's role in these diseases. Methods Patients who with liver cirrhosis or liver transplant patients from 2018 to 2024 were recruited from single hospital. A total of 4,064 patients with full data were studied. Patients were divided by serum bilirubin levels, and its association with CKD were studied in both liver cirrhosis and liver transplant patients. Results From each 3,827 liver cirrhosis and 237 liver transplant patients, 940 (24.6%) and 71 (30.0%) patients were also diagnosed of CKD (total n= 1,011). When divided by serum bilirubin levels, high serum bilirubin was associated with odds ratio (OR) of 1.97 (95% confidence interval (CI) 1.67-2.31) in liver cirrhosis patients after adjustment. However, no association was observed in liver transplant patients with OR of 0.85 (95% CI 0.41-1.77). Conclusions The current study has shown significant association between high bilirubin levels and increased CKD in liver cirrhosis patients but not in liver transplant patients.
Wilson’s disease (WD) is an autosomal recessive disorder resulting from mutations in the ATP7B gene. When chelation therapy proves ineffective, liver transplantation serves as the definitive treatment option. However, owing to the scarcity of cadaveric donor organs, living donor liver transplantation (LDLT) constitutes an important alternative. Nonetheless, the use of donors possessing compound heterozygous mutations in ATP7B and exhibiting low ceruloplasmin levels remains a subject of controversy.We report a 49-year-old woman with Wilson's disease (WD) who presented with liver cirrhosis, bleeding esophageal varices, and hepatocellular carcinoma. She underwent living donor liver transplantation (LDLT) from her 18-year-old son, who carried compound heterozygous mutations in the ATP7B gene and exhibited low ceruloplasmin and copper levels. Both the donor and recipient recovered well. The recipient’s liver function and copper metabolism normalized without the need for further chelation therapy.This case indicates that individuals who are compound heterozygous carriers of ATP7B with low ceruloplasmin levels may be considered suitable donors following a comprehensive assessment. A multidisciplinary approach is crucial to the donor selection process in Wilson's disease (WD).
Introduction Combined liver and kidney transplantation (CLKT) is a complex but essential procedure in selected patients with dual organ failure. We present our single-center experience with CLKT in children and adults. Materials and Methods We retrospectively analyzed 11 patients who underwent CLKT at our center between 1988 and 2024 regarding demographic and clinical data, including age, sex, transplant type (simultaneous/sequential), etiology, dialysis status, graft/patient survival, rejection, and oxalate levels. We also evaluated lymphocyte cross-match, panel reactive antibody screening, and complement-dependent cytotoxicity testing. Results Patients included 7 female and 4 male patients (mean age 18 years); 8 were pediatric and 3 were adult recipients. One patient with primary hyperoxaluria underwent a simultaneous liver-kidney transplant, and 10 patients received sequential transplants. Six patients were diagnosed with primary hyperoxaluria. The patient with simultaneous deceased donor transplant experienced early graft loss due to oxalate deposition and humoral rejection. Four patients experienced kidney graft rejection (1 cellular, 3 humoral). One patient with cryptogenic cirrhosis and persistent hepatorenal syndrome died from sepsis in the early postoperative period. A patient with progressive familial intrahepatic cholestasis later developed focal segmental glomerulosclerosis, which was potentially related to long-term tacrolimus exposure. Another patient required graft nephrectomy following thrombotic microangiopathy. The remaining 8 patients had favorable long-term outcomes without significant complications. Conclusions Our experience supports the staged transplant approach for hyperoxaluria and highlights the importance of individualized immunosuppressive strategies. Renal grafts were more susceptible, underscoring the need for vigilant immunologic assessment. Further multicenter studies are warranted to optimize transplant timing and improve outcomes in this complex patient population.
Fibrotic lung disease is strongly linked to short telomere syndrome (STS). The database “PubMed” was used to retrieve articles related to both STS and lung transplantation using the term “short telomere lung transplant.” STS with lung transplantation is associated with greater risk of primary graft dysfunction (PGD), graft versus host disease (GVHD), infections including cytomegalovirus (CMV), development of accelerated liver cirrhosis, bone marrow failure, chronic lung allograft rejection (CLAD), and malignancy. However, data related to the impact of STS on lung transplant survival and changes in immunosuppression is currently insufficient, contradictory, and yet to be elucidated.
Prostaglandin E1 (PGE1), also known as Alprostadil, has been widely studied for its positive effects in solid organ transplantation. This pharmacological agent offers notable benefits in heart, lung, and particularly liver and kidney transplants, leading to improved outcomes such as reduced ischaemia-reperfusion injury (IRI), better graft viability, and increased patient survival.Evidence suggests that PGE1 is effective in organ preservation, reducing IRI, preventing primary graft dysfunction, improving both short- and long-term survival, shortening stays in the intensive care unit (ICU), and decreasing the risk of acute kidney failure, especially after liver transplantation.The principal biological actions of PGE1, which make the compound a valuable tool in organ transplantation are the following: it acts as a vasodilator, improving organ perfusion by reducing peripheral vascular resistance in the kidney and liver. Furthermore, it provides cytoprotection and has anti-inflammatory effects, shielding cells and tissues from IRI, lowering oxidative stress, and moderating immune responses. Finally, PGE1 has established anti-platelet and fibrinolytic properties: it inhibits platelet aggregation and promotes fibrinolysis, further protecting the graft, impacting the platelet activation, and especially their release of potassium ions during activation. These combined effects—vasodilation, cytoprotection, anti-inflammation, and anti-platelet activity—lead to better clinical outcomes, including faster organ function recovery, improved graft and patient survival, and a reduced risk of acute rejection.In kidney transplantation, PGE1 has been shown to protect organs when administered during machine perfusion (but not during cold storage). It enhances renal function during reperfusion, lowers vascular resistance, and limits IRI, when given immediately after reperfusion. By reducing oxidative stress and inflammation, PGE1 supports quicker graft recovery and better overall results.PGE1’s rapid metabolism and widespread distribution of its receptors, along with well-understood receptor-mediated effects, make it a promising option for perioperative management in solid organ transplantation. Its capacity to reduce IRI, suppress inflammation, and support vascular function is supported by strong pre-clinical and clinical evidence.In the present review, we summarize available evidence that position PGE1 as a valuable therapeutic adjunct for improving transplantation outcomes.
Introduction Cardiac Allograft Vasculopathy (CAV) is a progressive manifestation of chronic allograft rejection in heart transplant recipients. While current diagnostic tools involve invasive and non-invasive imaging of coronary arterial anatomy and blood flow, circulating biomarkers can lead to earlier detection non-invasively. Objective The aim of this systematic review is to synthesize existing literature of prognostic and diagnostic circulating peripheral biomarkers of CAV. Methods A thorough literature search was performed on Pubmed, CINAHL, Scopus and Medline using the terms “cardiac allograft vasculopathy,” “CAV,” and “biomarkers.” Results The search yielded 1648 studies; 109 were included for the final review. Quality of evidence and risk of bias varied across the studies. Conclusion Multiple circulating biomarkers could help diagnose and prognosticate in the presence of CAV with variable diagnostic accuracy and predictability. The role of incorporating these biomarkers in traditional coronary imaging diagnostic paradigm of CAV remains to be studied.
Introduction The uncontrolled donation after circulatory death process is started upon cardiac arrest (CA). Although the initial objective of all emergency services is to recover a pulse after said CA, if this is not possible there is a possibility of initiating uncontrolled donation after circulatory death procedures. The aim of this study is to evaluate the actions implemented to resolve CA and how they may affect subsequent donation. Materials and methods A double-perspective observational study to study the association between the actions carried out to revert CA and the efficacy of donors in uncontrolled asystole. Data were collected between 2018 and November 2023. Patients who experienced an out-of-hospital CA with no response to advanced cardiopulmonary resuscitation, and who complied with all inclusion criteria and none of the exclusion criteria, were included. The following information was collected: age, sex, initial heart rate, adrenalin, amiodarone, serum therapy, inotropics, bicarbonate, magnesium sulfate, rapid intubation sequence, fibrinolysis, acetylsalicylic acid, atropine, number of defibrillations, use of an automatic defibrillator and discharges thereof, transitory recovery of pulse and initial heart rate. The statistical analysis was carried out using the R software package (ver. 4.1). An effective donor was defined as one from whom at least one organ was extracted and transplanted, and a non-effective donor as one from whom no organs were transplanted. Results A total of 69 patients, with a mean age of 49 years (43–52), the majority of whom were male (88.4 %), were collected. A total of 43 of these patients were non-effective donors and 26 were effective, with a statistically significant difference being found in terms of younger age (51 vs 46; p = 0.020). In the case of non-effective donors, eight adrenalin doses were administered compared with seven for the effective donor group, with the difference being statistically significant (p = 0.012). Fibrinolysis was used in eight cases (11.8 %), with two of these being non-effective donors and six effective; this difference was also statistically significant (p = 0.044). The remaining variables did not differ significantly. Conclusion On the basis of our series, only a lower use of adrenaline and the use of fibrinolytic agents appear to result in an effective donation if a pulse cannot be recovered. The other variables do not affect the efficacy of donation after uncontrolled circulatory death.
