Pub Date : 2026-01-03DOI: 10.1016/j.tpr.2026.100195
Joel Grunhut , Ruchin B. Patel , Silke V. Niederhaus , Jonathan S. Bromberg , Josue Alvarez-Casas , Kathryn Kline , Kapil K. Saharia , Chandra S. Bhati
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.
{"title":"Rapid tumor lysis after immunosuppressive pause in post-transplant lymphoproliferative disorder","authors":"Joel Grunhut , Ruchin B. Patel , Silke V. Niederhaus , Jonathan S. Bromberg , Josue Alvarez-Casas , Kathryn Kline , Kapil K. Saharia , Chandra S. Bhati","doi":"10.1016/j.tpr.2026.100195","DOIUrl":"10.1016/j.tpr.2026.100195","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Despite aggressive management, the patient deteriorated rapidly, culminating in respiratory failure, disseminated intravascular coagulation (DIC), and death.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"11 1","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.tpr.2025.100193
Kristina Akopyan , Moustafa Younis , Brandon Janssen , Cynthia Gries , Amir Emtiazjoo , Mindaugas Rackauskas , Biplab Saha
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.
{"title":"Short telomere syndrome in lung transplantation: What do we know so far?","authors":"Kristina Akopyan , Moustafa Younis , Brandon Janssen , Cynthia Gries , Amir Emtiazjoo , Mindaugas Rackauskas , Biplab Saha","doi":"10.1016/j.tpr.2025.100193","DOIUrl":"10.1016/j.tpr.2025.100193","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"11 1","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.tpr.2025.100192
K.H. Mun
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 4064 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 3827 liver cirrhosis and 237 liver transplant patients, 940 (24.6 %) and 71 (30.0 %) patients were also diagnosed of CKD (total n = 1011). 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.
背景肝硬化患者血清胆红素高，可作为肝功能不良及预后的标志。然而，胆红素具有抗炎和抗氧化作用，对肾功能有保护作用。因此，本研究研究了高胆红素水平与肝硬化患者慢性肾脏疾病（CKD）之间的关系，并将其与肝移植受者进行比较，以更好地了解胆红素在这些疾病中的作用。方法选取2018 ~ 2024年单个医院的肝硬化或肝移植患者。共有4064例具有完整资料的患者被纳入研究。按血清胆红素水平对患者进行分组，并在肝硬化和肝移植患者中研究其与CKD的关系。结果3827例肝硬化患者和237例肝移植患者中，分别有940例（24.6%）和71例（30.0%）被诊断为CKD（总n = 1011）。按血清胆红素水平划分，调整后肝硬化患者血清胆红素高与比值比（OR）为1.97（95%可信区间（CI） 1.67-2.31）相关。然而，在肝移植患者中没有观察到相关性，OR为0.85 （95% CI 0.41-1.77）。结论目前的研究显示高胆红素水平与肝硬化患者CKD增加有显著相关性，而与肝移植患者无显著相关性。
{"title":"Serum bilirubin as a risk factor of chronic kidney disease in liver cirrhosis, not liver transplant patients","authors":"K.H. Mun","doi":"10.1016/j.tpr.2025.100192","DOIUrl":"10.1016/j.tpr.2025.100192","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>Patients who with liver cirrhosis or liver transplant patients from 2018 to 2024 were recruited from single hospital. A total of 4064 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.</div></div><div><h3>Results</h3><div>From each 3827 liver cirrhosis and 237 liver transplant patients, 940 (24.6 %) and 71 (30.0 %) patients were also diagnosed of CKD (total <em>n</em> = 1011). 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).</div></div><div><h3>Conclusions</h3><div>The current study has shown significant association between high bilirubin levels and increased CKD in liver cirrhosis patients but not in liver transplant patients.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"11 1","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Improved knowledge of the health-related quality of life (HRQoL) of heart transplant patients is needed. However, collecting such data is often challenging. As part of a larger project aiming to implement HRQoL tools for heart transplant patients in a national heart transplant registry, this study evaluated the feasibility and acceptability of collecting HRQoL via patient interviews and a pilot test of three questionnaire administration methods.
Methods
Fourteen heart transplant recipients were asked about their experience with completing questionnaires and their general knowledge about QoL tools. Transcriptions of these interviews were analyzed using deductive thematic analysis, a cohort of heart transplant recipients was assigned to one of three QoL questionnaire delivery methods: e-mail, tablet, or Quick Response (QR) code. Participants completed two HRQoL questionnaires (the Medical Outcomes Study 12-item Short Form and the Medication Experience Scale in Immunosuppressants) using the assigned method and provided feedback on these tools.
Results
Interviews revealed five key themes related to HRQoL questionnaires: experience using them, perceived usefulness and purpose, desired characteristics, preferred administration methods, and specific HRQoL domains to be assessed. All recipients agreed that the questionnaire should be brief and easy to complete.
In total, 34 heart transplant recipients agreed to participate, but only 19 patients (12 men) actually completed the study. Participants preferred completing the questionnaire in the hospital setting. Each of the three administration methods was considered acceptable by most respondents.
Conclusions
The choice of a QoL measurement tool to be implemented within a heart transplant registry must take into account patient opinions to ensure successful long-term data collection. Electronic tools do not appear to represent a major barrier for patients.
{"title":"Feasibility and acceptance of electronic quality of life assessment in heart transplant recipients","authors":"Redouane Mahmoudi , Legeai Camille , Francis Guillemin , Cécile Couchoud","doi":"10.1016/j.tpr.2025.100194","DOIUrl":"10.1016/j.tpr.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>Improved knowledge of the health-related quality of life (HRQoL) of heart transplant patients is needed. However, collecting such data is often challenging. As part of a larger project aiming to implement HRQoL tools for heart transplant patients in a national heart transplant registry, this study evaluated the feasibility and acceptability of collecting HRQoL via patient interviews and a pilot test of three questionnaire administration methods.</div></div><div><h3>Methods</h3><div>Fourteen heart transplant recipients were asked about their experience with completing questionnaires and their general knowledge about QoL tools. Transcriptions of these interviews were analyzed using deductive thematic analysis, a cohort of heart transplant recipients was assigned to one of three QoL questionnaire delivery methods: e-mail, tablet, or Quick Response (QR) code. Participants completed two HRQoL questionnaires (the Medical Outcomes Study 12-item Short Form and the Medication Experience Scale in Immunosuppressants) using the assigned method and provided feedback on these tools.</div></div><div><h3>Results</h3><div>Interviews revealed five key themes related to HRQoL questionnaires: experience using them, perceived usefulness and purpose, desired characteristics, preferred administration methods, and specific HRQoL domains to be assessed. All recipients agreed that the questionnaire should be brief and easy to complete.</div><div>In total, 34 heart transplant recipients agreed to participate, but only 19 patients (12 men) actually completed the study. Participants preferred completing the questionnaire in the hospital setting. Each of the three administration methods was considered acceptable by most respondents.</div></div><div><h3>Conclusions</h3><div>The choice of a QoL measurement tool to be implemented within a heart transplant registry must take into account patient opinions to ensure successful long-term data collection. Electronic tools do not appear to represent a major barrier for patients.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"11 1","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1016/j.tpr.2025.100190
Hsin-Yen Chou , Chia-Feng Yang , Cheng-Yen Chen , Hsin-Lin Tsai , Hao-Jan Lei , Yi-Fan Tsou , Fang-Cheng Kuo , Meng-Hsuan Chung , Cheng-Yuan Hsia , Shu-Cheng Chou , Shen-Chih Wang , Chin-Su Liu , Niang-Cheng Lin
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).
{"title":"Living donor liver transplantation for Wilson’s disease from a compound heterozygote donor with a low ceruloplasmin level: a case report","authors":"Hsin-Yen Chou , Chia-Feng Yang , Cheng-Yen Chen , Hsin-Lin Tsai , Hao-Jan Lei , Yi-Fan Tsou , Fang-Cheng Kuo , Meng-Hsuan Chung , Cheng-Yuan Hsia , Shu-Cheng Chou , Shen-Chih Wang , Chin-Su Liu , Niang-Cheng Lin","doi":"10.1016/j.tpr.2025.100190","DOIUrl":"10.1016/j.tpr.2025.100190","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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).</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"11 1","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Combined liver and kidney transplantation: Experience and outcomes at Baskent university","authors":"Adem Şafak , Emre Karakaya , Sedat Yildirim , Nedim Çekmen , Adnan Torgay , Figen Özçay , Sıdıka Esra Baskin , Mehmet Haberal","doi":"10.1016/j.tpr.2025.100191","DOIUrl":"10.1016/j.tpr.2025.100191","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"11 1","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.tpr.2025.100185
Alonso A Mateos Rodriguez , Fernando Neria Serrano , Jose Maria Navalpotro Pascual , Maria Jose Polonio Anguas , Cristina de la Torre Toyos , Carlos Rubio Chacón
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.
在心脏骤停（CA）时开始循环死亡过程后的非受控捐献。尽管所有急救服务的最初目标都是在上述心脏骤停后恢复脉搏，但如果无法做到这一点，则有可能在循环性死亡程序后启动不受控制的捐赠。本研究的目的是评估为解决CA而实施的行动，以及它们如何影响随后的捐赠。材料与方法采用双视角观察性研究，研究供体无控制心脏骤停时CA恢复措施与供体疗效之间的关系。数据收集于2018年至2023年11月之间。经历过院外CA且对晚期心肺复苏无反应的患者，符合所有纳入标准而不符合排除标准的患者被纳入研究。收集以下信息：年龄、性别、初始心率、肾上腺素、胺碘酮、血清治疗、抗缩药、碳酸氢盐、硫酸镁、快速插管顺序、纤溶、乙酰水杨酸、阿托品、除颤器次数、自动除颤器使用及出院情况、短暂性脉搏恢复及初始心率。统计分析采用R软件包(ver。4.1)。有效供体被定义为至少从其身上提取并移植了一个器官，而非有效供体被定义为没有从其身上移植器官。结果共收集69例患者，平均年龄49岁（43 ~ 52岁），男性居多（88.4%）。无效献血者43例，有效献血者26例，在年龄上差异有统计学意义（51 vs 46; p = 0.020）。在非有效供体的情况下，给予8剂肾上腺素，而有效供体组给予7剂，差异有统计学意义（p = 0.012）。8例（11.8%）使用纤溶治疗，其中2例无效，6例有效；差异也有统计学意义（p = 0.044）。其余变量无显著差异。结论：根据我们的系列研究，如果脉搏不能恢复，只有较低的肾上腺素和纤溶药物的使用才会导致有效的捐献。其他变量不影响无控制循环性死亡后捐献的效果。
{"title":"Cardiopulmonary resuscitation does not affect donation in uncontrolled donation after circulatory death procedures","authors":"Alonso A Mateos Rodriguez , Fernando Neria Serrano , Jose Maria Navalpotro Pascual , Maria Jose Polonio Anguas , Cristina de la Torre Toyos , Carlos Rubio Chacón","doi":"10.1016/j.tpr.2025.100185","DOIUrl":"10.1016/j.tpr.2025.100185","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>p</em> = 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 (<em>p</em> = 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 (<em>p</em> = 0.044). The remaining variables did not differ significantly.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 4","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.tpr.2025.100188
Markus Dehnhardt , Bettina Leber , Gerd Wawrik , Philipp Stiegler
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.
{"title":"Prostaglandin E1 (PGE1) in renal transplantation","authors":"Markus Dehnhardt , Bettina Leber , Gerd Wawrik , Philipp Stiegler","doi":"10.1016/j.tpr.2025.100188","DOIUrl":"10.1016/j.tpr.2025.100188","url":null,"abstract":"<div><div>Prostaglandin E1 (PGE<sub>1</sub>), 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.</div><div>Evidence suggests that PGE<sub>1</sub> 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.</div><div>The principal biological actions of PGE<sub>1</sub>, 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, PGE<sub>1</sub> 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.</div><div>In kidney transplantation, PGE<sub>1</sub> 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, PGE<sub>1</sub> supports quicker graft recovery and better overall results.</div><div>PGE<sub>1</sub>’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.</div><div>In the present review, we summarize available evidence that position PGE<sub>1</sub> as a valuable therapeutic adjunct for improving transplantation outcomes.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 4","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.tpr.2025.100187
Carola Ginevra Ciarlini, Konrad Fischer
This review explores the use of brain-dead organ recipients for transplantation studies, focusing on recent advancements and the scientific rationale behind this approach. Brain-dead patients serve as a crucial pre-clinical model to test the safety and feasibility of xenotransplantation, allowing researchers to assess surgical complications, immune responses, and organ function without the ethical concerns associated with living human subjects. Notable studies from the University of Alabama at Birmingham, the New York University, the University of Pennsylvania and the Air Force Medical University in Xi'an have demonstrated the potential of genetically modified pig organs, such as kidneys, hearts and livers, to reduce immune rejection and improve graft survival. These experiments highlight the complexities of managing systemic physiological responses and the need for sophisticated extracorporeal life support systems. Additionally, the ethical and legal implications of using brain-dead patients for such experimental procedures are considered, underscoring the importance of informed consent and regulatory oversight. This review underscores the promise of xenotransplantation in addressing organ shortages and advancing transplant medicine.
{"title":"Organ transplantation in brain-dead patients: Integrating immunology, life support, case studies, legal, and ethical considerations for future therapeutics","authors":"Carola Ginevra Ciarlini, Konrad Fischer","doi":"10.1016/j.tpr.2025.100187","DOIUrl":"10.1016/j.tpr.2025.100187","url":null,"abstract":"<div><div>This review explores the use of brain-dead organ recipients for transplantation studies, focusing on recent advancements and the scientific rationale behind this approach. Brain-dead patients serve as a crucial pre-clinical model to test the safety and feasibility of xenotransplantation, allowing researchers to assess surgical complications, immune responses, and organ function without the ethical concerns associated with living human subjects. Notable studies from the University of Alabama at Birmingham, the New York University, the University of Pennsylvania and the Air Force Medical University in Xi'an have demonstrated the potential of genetically modified pig organs, such as kidneys, hearts and livers, to reduce immune rejection and improve graft survival. These experiments highlight the complexities of managing systemic physiological responses and the need for sophisticated extracorporeal life support systems. Additionally, the ethical and legal implications of using brain-dead patients for such experimental procedures are considered, underscoring the importance of informed consent and regulatory oversight. This review underscores the promise of xenotransplantation in addressing organ shortages and advancing transplant medicine.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 4","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Serum biomarkers in cardiac allograft vasculopathy: A systematic review","authors":"Farhan Ishaq , Nadia Fida , Rajarajan A. Thandavarayan , Stefano Casarin , Ashrith Guha","doi":"10.1016/j.tpr.2025.100186","DOIUrl":"10.1016/j.tpr.2025.100186","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Objective</h3><div>The aim of this systematic review is to synthesize existing literature of prognostic and diagnostic circulating peripheral biomarkers of CAV.</div></div><div><h3>Methods</h3><div>A thorough literature search was performed on Pubmed, CINAHL, Scopus and Medline using the terms “cardiac allograft vasculopathy,” “CAV,” and “biomarkers.”</div></div><div><h3>Results</h3><div>The search yielded 1648 studies; 109 were included for the final review. Quality of evidence and risk of bias varied across the studies.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"10 4","pages":"Article 100186"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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