Browsing by Subject "Cause of Death"

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  • Helanterä, Ilkka; Ibrahim, Hassan N.; Lempinen, Marko; Finne, Patrik (2020)
    Background and objectives Increased donor age is one of the most important risk factors for delayed graft function (DGF), and previous studies suggest that the harmful effect of cold ischemia time is increased in kidneys from older donors. Our aim was to study the association of increased donor age and cold ischemia time with the risk of delayed graft function in a large cohort kidney transplants from the current era. Design, setting, participants, & measurements The Scientific Registry of Transplant Recipients was used for this observational, retrospective registry analysis to identify all deceased donor kidney transplantations in the United States between 2010 and September 2018, who were on dialysis pretransplantation (n=90,810). The association of donor age and cold ischemia time with the risk of DGF was analyzed in multivariable models adjusted for recipient characteristics (age, race, sex, diabetes, calculated panel-reactive antibodies, pretransplant dialysis duration) and donor characteristics (cause of death, sex, race, body mass index, creatinine, donation after circulatory death status, history of hypertension, and HLA mismatch). Results Cold ischemia time and donor age were independently associated with the risk of DGF, but the risk of DGF was not statistically significantly lower in donor age categories between 50 and 64 years, compared with donors ?65 years. The harmful association of cold ischemia time was not higher in kidneys from older donors in any age category, not even among donation after circulatory death donors. When donor risk was assessed with kidney donor profile index, although a statistically significant interaction with cold ischemia time was found, no practically meaningful increase in cold-ischemia susceptibility of kidneys with a high kidney donor profile index was found. Conclusions We were unable to demonstrate an association between donor age and DGF. The association of longer cold ischemia time with the risk of DGF was not magnified in older or more marginal donors.
  • Rauhala, Auvo; Ylihärsilä, Heli; Aaltonen, Leena-Maija; Roine, Risto P.; Kinnunen, Marina (2018)
    Sairaalassa tapahtuneiden kuolemien systemaattinen selvittely on Suomessa jäänyt liian vähälle huomiolle. Terveydenhuollon vakavimmasta haittatapahtumasta voidaan – ja pitää – ottaa opiksi.
  • Koivusalo, Anna-Maria (2020)
    Potentiaalisen elinluovuttajan tunnistaminen ja asianmukainen hoito on tärkeää, sillä siirrettävistä elimistä on pulaa. Elinluovutus- ja elinsiirtotoiminta on Suomessa keskitetty, ja sitä säätelevät tarkat lait ja ohjeistukset.
  • Kinnunen, Susanna; Karhapää, Pauli; Juutilainen, Auni; Finne, Patrik; Helanterä, Ilkka (2018)
    Background and objectives Infections are the most common noncardiovascular causes of death after kidney transplantation. We analyzed the current infection-related mortality among kidney transplant recipients in a nationwide cohort in Finland. Design, setting, participants, & measurements Altogether, 3249 adult recipients of a first kidney transplant from 1990 to 2012 were included. Infectious causes of death were analyzed, and the mortality rates for infections were compared between two eras (1990-1999 and 2000-2012). Risk factors for infectious deaths were analyzed with Cox regression and competing risk analyses. Results Altogether, 953 patients (29%) died during the follow-up, with 204 infection-related deaths. Mortality rate (per 1000 patient-years) due to infections was lower in the more recent cohort (4.6; 95% confidence interval, 3.5 to 6.1) compared with the older cohort (9.1; 95% confidence interval, 7.6 to 10.7); the incidence rate ratio of infectious mortality was 0.51 (95% confidence interval, 0.30 to 0.68). The main causes of infectious deaths were common bacterial infections: septicemia in 38% and pulmonary infections in 45%. Viral and fungal infections caused only 2% and 3% of infectious deaths, respectively (such as individual patients with Cytomegalovirus pneumonia, Herpes simplex virus meningoencephalitis, Varicella zoster virus encephalitis, and Pneumocystis jirovecii infection). Similarly, opportunistic bacterial infections rarely caused death; only one deathwas caused by Listeria monocytogenes, and two were caused by Mycobacterium tuberculosis. Only 23 (11%) of infection-related deaths occurred during the first post-transplant year. Older recipient age, higher plasma creatinine concentration at the end of the first post-transplant year, diabetes as a cause of ESKD, longer pretransplant dialysis duration, acute rejection, low albumin level, and earlier era of transplantation were associated with increased risk of infectious death in multivariable analysis. Conclusions The risk of death due to infectious causes after kidney transplantation in Finland dropped by one half since the 1990s. Common bacterial infections remained the most frequent cause of infection-related mortality, whereas opportunistic viral, fungal, or unconventional bacterial infections rarely caused deaths after kidney transplantation.
  • Tarkiainen, Lasse; Martikainen, Pekka; Peltonen, Riina; Remes, Hanna (2017)
    Lähtökohdat Koulutusryhmien ja etenkin tuloryhmien väliset sosioekonomiset erot elinajanodotteessa kasvoivat merkittävästi v. 1988–2007. Kasvu johtui pääasiassa alimman tuloviidenneksen elinajanodotteen epäsuotuisasta kehityksestä alkoholikuolleisuuden lisäännyttyä. Menetelmät Tutkimus perustuu Tilastokeskuksen väestörekisteriaineistoihin ja kattaa Suomessa v. 1996–2014 asuneet henkilöt. 25-vuotiaiden elinajanodotteet laskettiin vuosittain ja neljän vuoden jaksoissa miehille ja naisille tuloviidenneksittäin ja koulutusryhmittäin. Elinajanodotteiden erot ja muutokset sosiaaliryhmittäin analysoitiin ikäluokan ja kuolemansyyn mukaan jaksoilta 2006–09 ja 2011–14. Tulokset Ylimmän ja alimman tulo- ja koulutusryhmän elinajanodotteen erojen kasvu on pysähtynyt ja jopa kaventui hieman 2010-luvulla lukuun ottamatta naisten eroja koulutusryhmittäin. Alimman tuloviidenneksen elinajanodote lähti jälleen kasvuun 2010-luvulla, kun alkoholiperäinen, tapaturmainen ja väkivaltainen kuolleisuus väheni alimmissa sosiaaliryhmissä etenkin miehillä. Naisilla erot syöpäkuolleisuudessa ovat yhä kasvaneet. Päätelmät Erot elinajanodotteessa ovat yhä suuret, vaikka tulo- ja koulutusryhmien ero kaventui hieman. ¬Alkoholikuolleisuuden vähenemisellä oli suuri merkitys erojen kaventumiseen etenkin miehillä. Kuolleisuuserot saattavat selvästi pienentyä, jos alimmissa sosiaaliryhmissä edistetään alkoholiperäisistä ja iskeemisistä sydänsairauksista johtuvan kuolleisuuden vähenemistä.