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11. The first 10 years of simultaneous pancreas‐kidney transplantation in Finland

Author

Ahopelto, Kaisa, primary, Sallinen, Ville, additional, Helanterä, Ilkka, additional, Bonsdorff, Akseli, additional, Grasberger, Juulia, additional, Beilmann‐Lehtonen, Ines, additional, Mäkisalo, Heikki, additional, Nordin, Arno, additional, Ortiz, Fernanda, additional, Savikko, Johanna, additional, Tukiainen, Eija, additional, Uutela, Aki, additional, Ekstrand, Agneta, additional, and Lempinen, Marko, additional

Published
2023
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16. Timing of Organ Procurement From Brain-Dead Donors Associates With Short- and Long-Term Outcomes After Liver Transplantation

Author

Eerola, Verner, Helanterä, Ilkka, Åberg, Fredrik, Lempinen, Marko, Mäkisalo, Heikki, Nordin, Arno, Isoniemi, Helena, Sallinen, Ville, Clinicum, HUS Abdominal Center, IV kirurgian klinikka, Pertti Panula / Principal Investigator, Department of Anatomy, and Helsinki University Hospital Area

Subjects
organ allocation, liver allograft function, Transplantation, Tissue and Organ Procurement, DURATION, graft survival, liver transplant dysfunction, Brain, donor hepatectomy, 3126 Surgery, anesthesiology, intensive care, radiology, Severity of Illness Index, Liver Transplantation, TIME, End Stage Liver Disease, ACTIVATION, procurement surgery, SURVIVAL, Humans, brain death, FAILURE
Abstract

Brain death-induced cytokine storm is thought to harm transplantable organs. However, longer procurement times have been associated with non-inferior or better outcomes in kidney, heart, and lung transplants, while optimal procurement time for liver allografts is unknown. Our aim was to analyze the association of time interval from brain death to organ procurement with liver allograft outcomes in two nationwide cohorts. The association of procurement interval with graft survival and short-term complications was analysed in multivariable models. Altogether 643 and 58,017 orthotopic liver transplantations from brain-dead donors were included from Finland between June 2004 and December 2017 and the US between January 2008 and August 2018, respectively. Median time from brain death to organ procurement was 10.5 h in Finland and 34.6 h in the US. Longer interval associated with better graft survival (non-linearly, p = 0.016) and less acute rejections (OR 0.935 95% CI 0.894–0.978) in the US cohort, and better early allograft function (p = 0.005; Beta −0.048 95% CI −0.085 −(−0.011)) in the Finnish cohort, in multivariable models adjusted with Donor Risk Index, recipient age, Model for End-Stage Liver Disease and indication for transplantation. Progressive liver injury after brain death is unlikely. Rushing to recover seems unnecessary; rest and repair might prove beneficial.

Published
2022
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18. Pasireotide Versus Octreotide in Preventing Complications After Simultaneous Pancreas-Kidney Transplantation.

Author

Ahopelto, Kaisa, Bonsdorff, Akseli, Grasberger, Juulia, Lempinen, Marko, Nordin, Arno, Helanterä, Ilkka, and Sallinen, Ville

Subjects
KIDNEY transplantation, PANCREATIC surgery, ELECTIVE surgery, SURGICAL complications, PANCREAS transplantation, REOPERATION, PANCREAS
Abstract

In elective pancreatic surgery, somatostatin-analogues pasireotide and octreotide are variably used to reduce postoperative complications, but knowledge on their role in pancreas transplantation is limited. This study compared pasireotide and octreotide for their association with complications after simultaneous pancreas-kidney transplantation (SPK). This retrospective study included consecutive patients undergoing SPK’s from July 2013 to July 2022. Between July 2013 and April 2020, octreotide was administered 0.1 mg s.c. once daily and between May 2020 and July 2022 pasireotide was administered 0.9 mg twice daily, both until third postoperative day. Complications within 90 days postoperatively were collected, and reoperation rate and Comprehensive Complication index (CCI) ≥ 33.7 (morbidity equal to one reoperation) were used as primary outcomes. Of the 213 patients undergoing SPK, 150 patients received octreotide and 63 pasireotide. Baseline characteristics were comparable. Reoperation rate was 25.3% (n = 38) and 17.5% (n = 11) (p = 0.213) and rate of CCI ≥ 33.7 was 40.7% (n = 61) and 30.2% (n = 19) (p = 0.148) in octreotide and pasireotide groups, respectively. When adjusted with donor BMI, pancreas donor risk index, and donor sex, receiving pasireotide translated into OR 0.49 (95% CI: 0.25–0.96 p = 0.037) for CCI ≥ 33.7. Pasireotide was independently associated with lower postoperative morbidity within 90 days of SPK compared to octreotide. [ABSTRACT FROM AUTHOR]

Published
2023
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22. Elinluovutus kuoleman jälkeen

Author

Koivusalo, Anna-Maria, Nordin, Arno, Lempinen, Marko, Ulander, Veli-Matti, Ala-Kokko, Tero, HUS Leikkaussalit, teho- ja kivunhoito, HUS Vatsakeskus, and IV kirurgian klinikka

Subjects
Death, Brain Death, 3126 Kirurgia, anestesiologia, tehohoito, radiologia, +legislation & jurisprudence, Organ Transplantation, Unrelated Donors, Tissue Donors
Abstract

Vertaisarvioitu. English summary. • Elinsiirrot ovat kustannustehokasta hoitoa. Niitä rajoittaa elinluovuttajien määrä ja siirrännäisten puute. • Elinsiirto- ja -luovutustoimintaa säädellään ja valvotaan tarkkaan lailla. • Luovuttajien määrää on yritetty lisätä lainsäädännöllä ja toimintaa koordinoimalla. • Kuolleet elinluovuttajat Suomessa ovat olleet aivokuolleita. • Monissa maissa on käytössä elinluovutus verenkierron pysähtymisen ja kuoleman toteamisen jälkeen -toiminta. Se mahdollistaa elinluovutuksen potilaalta, jolla on palautumaton aivovaurio mutta tila ei etene aivokuolemaan. Tämä toiminta on tarkoitus aloittaa myös Suomessa.

Published
2021

25. Munuaisensiirto elävältä luovuttajalta

Author

Helanterä, Ilkka, Ahopelto, Kaisa, Lempinen, Marko, HUS Vatsakeskus, Nefrologian yksikkö, IV kirurgian klinikka, and Kirurgian osasto

Subjects
Transplantation Conditioning, Risk Factors, 3126 Kirurgia, anestesiologia, tehohoito, radiologia, Living Donors, Kidney Transplantation, Tissue Donors
Abstract

Teema : elinsiirrot Munuaisensiirtoja elävältä luovuttajalta on Suomessa perinteisesti tehty vain vähän, mutta niiden määrää on viime vuosina pyritty lisäämään. Uusi kudoslaki mahdollistaa yhä useamman toimimisen elävänä luovuttajana. Munuaisluovuttajan riskit ovat vähäiset ja nykyään erittäin hyvin tunnetut.

Published
2020

26. Mitä uutta elinsiirtorintamalla?

Author

Lempinen, Marko, Ahopelto, Kaisa, Sallinen, Ville, HUS Vatsakeskus, IV kirurgian klinikka, Kirurgian osasto, Clinicum, Pertti Panula / Vastuullinen tutkija, and Anatomian osasto

Subjects
Cryopreservation, Ischemia, 3126 Kirurgia, anestesiologia, tehohoito, radiologia, Transplants, Organ Transplantation, Heart Arrest
Abstract

Teema : elinsiirrot

Published
2020

27. Enemmän elinsiirtoja verenkierron pysähtymisen jälkeisillä elinluovutuksilla

Author

Lempinen, Marko, Koivusalo, Anna-Maria, IV kirurgian klinikka, HUS Vatsakeskus, Diagnostis-terapeuttinen osasto, Clinicum, and HUS Leikkaussalit, teho- ja kivunhoito

Subjects
Tissue and Organ Procurement, 3126 Kirurgia, anestesiologia, tehohoito, radiologia, Organ Transplantation, Tissue Donors
Published
2020

28. Relative and absolute cancer risks among Nordic kidney transplant recipients-a population-based study

Author

Benoni, Henrik, Eloranta, Sandra, Dahle, Dag O., Svensson, My H. S., Nordin, Arno, Carstens, Jan, Mjoen, Geir, Helantera, Ilkka, Hellstrom, Vivan, Enblad, Gunilla, Pukkala, Eero, Sorensen, Soren S., Lempinen, Marko, Smedby, Karin E., Benoni, Henrik, Eloranta, Sandra, Dahle, Dag O., Svensson, My H. S., Nordin, Arno, Carstens, Jan, Mjoen, Geir, Helantera, Ilkka, Hellstrom, Vivan, Enblad, Gunilla, Pukkala, Eero, Sorensen, Soren S., Lempinen, Marko, and Smedby, Karin E.

Abstract

Kidney transplant recipients (KTRs) have an increased cancer risk compared to the general population, but absolute risks that better reflect the clinical impact of cancer are seldom estimated. All KTRs in Sweden, Norway, Denmark, and Finland, with a first transplantation between 1995 and 2011, were identified through national registries. Post-transplantation cancer occurrence was assessed through linkage with cancer registries. We estimated standardized incidence ratios (SIR), absolute excess risks (AER), and cumulative incidence of cancer in the presence of competing risks. Overall, 12 984 KTRs developed 2215 cancers. The incidence rate of cancer overall was threefold increased (SIR 3.3, 95% confidence interval [CI]: 3.2-3.4). The AER of any cancer was 1560 cases (95% CI: 1468-1656) per 100 000 person-years. The highest AERs were observed for nonmelanoma skin cancer (838, 95% CI: 778-901), non-Hodgkin lymphoma (145, 95% CI: 119-174), lung cancer (126, 95% CI: 98.2-149), and kidney cancer (122, 95% CI: 98.0-149). The five- and ten-year cumulative incidence of any cancer was 8.1% (95% CI: 7.6-8.6%) and 16.8% (95% CI: 16.0-17.6%), respectively. Excess cancer risks were observed among Nordic KTRs for a wide range of cancers. Overall, 1 in 6 patients developed cancer within ten years, supporting extensive post-transplantation cancer vigilance.

Published
2020
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34. Randomised sham-controlled double-blind trial evaluating remote ischaemic preconditioning in solid organ transplantation: a study protocol for the RIPTRANS trial

Author

Uutela, Aki, primary, Helanterä, Ilkka, additional, Lemström, Karl, additional, Passov, Arie, additional, Syrjälä, Simo, additional, Åberg, Fredrik, additional, Mäkisalo, Heikki, additional, Nordin, Arno, additional, Lempinen, Marko, additional, and Sallinen, Ville, additional

Published
2020
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35. Relative and absolute cancer risks among Nordic kidney transplant recipients—a population‐based study

Author

Benoni, Henrik, primary, Eloranta, Sandra, additional, Dahle, Dag O., additional, Svensson, My H.S., additional, Nordin, Arno, additional, Carstens, Jan, additional, Mjøen, Geir, additional, Helanterä, Ilkka, additional, Hellström, Vivan, additional, Enblad, Gunilla, additional, Pukkala, Eero, additional, Sørensen, Søren S., additional, Lempinen, Marko, additional, and Smedby, Karin E., additional

Published
2020
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40. Letermovir treatment for CMV infection in kidney and pancreas transplantation: A valuable option for complicated cases.

Author

Ortiz, Fernanda, Lempinen, Marko, Aaltonen, Sari, Koivuviita, Niina, and Helanterä, Ilkka

Subjects
*PANCREAS transplantation, *CYTOMEGALOVIRUS diseases, *KIDNEY transplantation, *TRANSPLANTATION of organs, tissues, etc., *ELECTRONIC health records, *INTRA-abdominal infections, *VIRAL encephalitis
Abstract

Cytomegalovirus (CMV) infection remains a major challenge in solid organ transplantation. Ganciclovir has changed the prognosis, but with the expense of possible viral resistance. New antiviral drugs, such as letermovir, have not been studied sufficiently in kidney and pancreas transplant recipients. We reviewed abdominal organ transplants recipients with CMV infection from the national transplant registry and identified patients treated with letermovir from electronic medical records. We report on letermovir treatment in one kidney and three simultaneous pancreas and kidney (SPK) transplant patients with refractory or ganciclovir‐resistant CMV infection (UL54/ UL97 mutation). In SPK patients, persistent leukopenia undermined immunosuppressive and antiviral treatment, favoring life‐threatening bacterial infections or ganciclovir resistance. All patients achieved viral clearance after letermovir monotherapy of 1.5–6 months. Letermovir was well tolerated and leukopenia resolved. Adjustments of calcineurin inhibitor doses were challenging. One acute rejection occurred because of under immunosuppression. After the end of treatment, recurrent low‐grade CMV‐DNAemia was common requiring reinitiating antiviral therapy to achieve viral clearance. To conclude, letermovir was a well‐tolerated valuable option for the treatment of refractory or resistant CMV infection in kidney and pancreas transplantation. [ABSTRACT FROM AUTHOR]

Published
2022
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41. Munuaisensiirtolistalle pääsee nyt ilman edeltävää dialyysihoitoa

Author

Finne, Patrik, Helanterä, Ilkka, Lempinen, Marko, Nefrologian yksikkö, Sisätautien osasto, Clinicum, IV kirurgian klinikka, and HUS Vatsakeskus

Subjects
+pathology, Time Factors, Waiting Lists, Renal Dialysis, Cost-Benefit Analysis, 3126 Kirurgia, anestesiologia, tehohoito, radiologia, Transplants, Kidney, Kidney Transplantation, Tissue Donors
Abstract

Odotusajan lyheneminen vaikuttaisi suotuisasti potilaiden elämään.

Published
2019

45. Kidney transplant outcomes from older deceased donors: A paired kidney analysis by the ERA-EDTA Registry

Author

Pippias, Maria, Jager, Kitty J., Caskey, Fergus, Casula, Anna, Erlandsson, Helen, Finne, Patrik, Heaf, James, Heinze, Georg, Hoitsma, Andries, Kramar, Reinhard, Lempinen, Marko, Magaz, Angela, Midtvedt, Karsten, Mumford, Lisa L., Pascual, Julio, Prütz, Karl G., Sørensen, Søren S., Traynor, Jamie P., Massy, Ziad A., Ravanan, Rommel, Stel, Vianda S., APH - Quality of Care, APH - Aging & Later Life, Medical Informatics, APH - Global Health, and ACS - Pulmonary hypertension & thrombosis

Abstract

As the median age of deceased kidney donors rises, updated knowledge of transplant outcomes from older deceased donors in differing donor-recipient age groups is required. Using ERA-EDTA Registry data we determined survival outcomes of kidney allografts donated from the same older deceased donor (55-70 years), and transplanted into one recipient younger and one recipient of similar age to the donor. The recipient pairs were divided into two groups: group 1; younger (median age: 52 years) and older (60 years), and group 2; younger (41 years) and older (60 years). 1,410 adults were transplanted during 2000-2007. Compared to the older recipients the mean number of functioning graft years at 10-years was six months longer in the group 1 and group 2 younger recipients (p

Published
2018

49. Calcium : A Crucial Potentiator for Efficient Enzyme Digestion of the Human Pancreas

Author

Eich, Torsten, Ståhle, Magnus U., Gustafsson, Bengt, Horneland, Rune, Lempinen, Marko, Lundgren, Torbjorn, Rafael, Ehab, Tufveson, Gunnar, von Zur-Mühlen, Bengt, Olerud, Johan, Scholz, Hanne, Korsgren, Olle, Eich, Torsten, Ståhle, Magnus U., Gustafsson, Bengt, Horneland, Rune, Lempinen, Marko, Lundgren, Torbjorn, Rafael, Ehab, Tufveson, Gunnar, von Zur-Mühlen, Bengt, Olerud, Johan, Scholz, Hanne, and Korsgren, Olle

Abstract

Background: Effective digestive enzymes are crucial for successful islet isolation. Supplemental proteases are essential because they synergize with collagenase for effective pancreatic digestion. The activity of these enzymes is critically dependent on the presence of Ca2+ ions at a concentration of 5–10 mM. The present study aimed to determine the Ca2+ concentration during human islet isolation and to ascertain whether the addition of supplementary Ca2+ is required to maintain an optimal Ca2+ concentration during the various phases of the islet isolation process. Methods: Human islets were isolated according to standard methods and isolation parameters. Islet quality control and the number of isolations fulfilling standard transplantation criteria were evaluated. Ca2+ was determined by using standard clinical chemistry routines. Islet isolation was performed with or without addition of supplementary Ca2+ to reach a Ca2+ of 5 mM. Results: Ca2+ concentration was markedly reduced in bicarbonate-based buffers, especially if additional bicarbonate was used to adjust the pH as recommended by the Clinical Islet Transplantation Consortium. A major reduction in Ca2+ concentration was also observed during pancreatic enzyme perfusion, digestion, and harvest. Additional Ca2+ supplementation of media used for dissolving the enzymes and during digestion, perfusion, and harvest was necessary in order to obtain the concentration recommended for optimal enzyme activity and efficient liberation of a large number of islets from the human pancreas. Conclusions: Ca2+ is to a large extent consumed during clinical islet isolation, and in the absence of supplementation, the concentration fell below that recommended for optimal enzyme activity. Ca2+ supplementation of the media used during human pancreas digestion is necessary to maintain the concentration recommended for optimal enzyme activity. Addition of Ca2+ to the enzyme blend has been implemented in the standard isolation protocols

Published
2018
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50. CalciumA Crucial Potentiator for Efficient Enzyme Digestion of the Human Pancreas

Author

Eich, Torsten, Ståhle, Magnus, Gustafsson, Bengt, Horneland, Rune, Lempinen, Marko, Lundgren, Torbjörn, Rafael, Ehab, Tufveson, Gunnar, von Zur-Mühlen, Bengt, Olerud, Johan, Scholz, Hanne, Korsgren, Olle, Eich, Torsten, Ståhle, Magnus, Gustafsson, Bengt, Horneland, Rune, Lempinen, Marko, Lundgren, Torbjörn, Rafael, Ehab, Tufveson, Gunnar, von Zur-Mühlen, Bengt, Olerud, Johan, Scholz, Hanne, and Korsgren, Olle

Abstract

Background: Effective digestive enzymes are crucial for successful islet isolation. Supplemental proteases are essential because they synergize with collagenase for effective pancreatic digestion. The activity of these enzymes is critically dependent on the presence of Ca2+ ions at a concentration of 5–10 mM. The present study aimed to determine the Ca2+ concentration during human islet isolation and to ascertain whether the addition of supplementary Ca2+ is required to maintain an optimal Ca2+ concentration during the various phases of the islet isolation process. Methods: Human islets were isolated according to standard methods and isolation parameters. Islet quality control and the number of isolations fulfilling standard transplantation criteria were evaluated. Ca2+ was determined by using standard clinical chemistry routines. Islet isolation was performed with or without addition of supplementary Ca2+ to reach a Ca2+ of 5 mM. Results: Ca2+ concentration was markedly reduced in bicarbonate-based buffers, especially if additional bicarbonate was used to adjust the pH as recommended by the Clinical Islet Transplantation Consortium. A major reduction in Ca2+ concentration was also observed during pancreatic enzyme perfusion, digestion, and harvest. Additional Ca2+ supplementation of media used for dissolving the enzymes and during digestion, perfusion, and harvest was necessary in order to obtain the concentration recommended for optimal enzyme activity and efficient liberation of a large number of islets from the human pancreas. Conclusions: Ca2+ is to a large extent consumed during clinical islet isolation, and in the absence of supplementation, the concentration fell below that recommended for optimal enzyme activity. Ca2+ supplementation of the media used during human pancreas digestion is necessary to maintain the concentration recommended for optimal enzyme activity. Addition of Ca2+ to the enzyme blend has been implemented in the standard isolation protocols

Published
2018

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