Selected activities in Scandiatransplant

Scandiatransplant is the Nordic organ exchange organization. It has existed for 35 years and it is owned by all organ transplantation hospital departments in the five Nordic countries--Denmark, Finland, Iceland, Norway, and Sweden. The use of living organ donors for kidney transplantation has become a more common procedure not only in Norway but also in Sweden and Denmark. For the first time, in 2003, one transplant center performed relatively more living donor kidney transplantations than with deceased donors. The overall organ transplant activity reveals a remarkably stable situation in the area covered by Scandiatransplant. Scandiatransplant as an organ exchange organization has changed from a solely kidney exchange organization to an organization in which the more immediate vital organs as liver and heart are exchanged more commonly than kidneys.

Cutaneous infection caused by Paecilomyces lilacinus in a renal transplant patient: treatment with voriconazole

Moulds belonging to the genus Paecilomyces are rare opportunistic pathogens. About 100 cases have been reported in immunocompromised hosts or in relation to surgical procedures. We describe here a cutaneous infection due to P. lilacinus in a renal transplant patient, which responded to voriconazole treatment.

[Access to transplantation organs in Iceland.]

After the first kidney transplantation into an Icelandic patient in 1970 and until 1993 Iceland was dependent upon the Nordic institution Scandiatransplant for transplantation of cadaveric kidneys. During that period 40 cadaveric kidneys were transplanted into Icelandic patients at Rigshospitalet in Copenhagen. The first liver was transplanted into an Icelander in London in 1985 and two in addition until 1993. The first heart was also transplanted into an Icelandic patient in London in 1988 and additional two until 1993. In 1991 the Icelandic parliament passed laws on the definition of death and procurement of organs for transplantation. This made it possible to provide organs to the Scandiatransplant collaboration. In 1993 a contract was made with the Sahlgrenska University Hospital in Gothenburg in which Sahlgrenska was committed to transplant necroorgans into Icelandic patients as well as to procurement of organs when available in Iceland. This cooperation lasted until the end of 1996 when a similar agreement was made with Rigshospitalet in Copenhagen. From 1993-1999 altogether 28 necroorgan transplantations were performed on Icelanders (three hearts, three hearts and lungs, three lungs, seven livers and 12 kidneys). During the same period organs were procured 24 times. Transplantation of kidneys from living Icelandic donors has increased dramatically constituting 69% of all kidney transplantations 1990-1999. Living donor transplantations into Icelanders were altogether 56 at the end of 1999.

Scandiatransplant: thirty years of cooperation in organ transplantation in the Nordic countries

The Nordic organ exchange organization, Scandiatransplant was established in 1969. The organization, which covers a population of 23.9 million inhabitants, includes all 11 organ transplant centers in the 5 Nordic countries Denmark, Finland, Iceland, Norway and Sweden. The economy is solely based on transplant center fees. All Nordic patients waiting for an organ transplant are registered on one common waiting list. Rules for the exchange of organs are settled by unanimous decision, and the compliance to the rules is excellent. Kidney exchange is based on HLA matching, whereas the exchange of livers and hearts is based on clinical urgency. In 1997, 43% of the liver transplantations in Scandiatransplant were performed with an exchanged organ and the exchange rate for kidneys was 20%. Currently, the Scandiatransplant waiting list includes 1,538 patients waiting for a kidney transplant, 20 patients are waiting for a liver, 37 for a heart, and 156 patients are waiting for a lung transplant. The organ donation rate in Scandiatransplant has declined in recent years, from 16.0 per million population (PMP) in 1993 to a level of 13.5 PMP in 1997. The number of kidney transplants has varied between 800-900 per year during the past 10 years, corresponding to 33-38 transplants PMP. Approximately 30% of the renal transplants were performed with kidneys from living donors. The liver transplantation activity was approximately 7 PMP per year. Heart transplantation was performed at a rate of 4-5 PMP per year, and lung transplants at 4 PMP per year.

[Autosomal dominant polycystic kidney disease in Iceland - genetic study.]

OBJECTIVE

Autosomal dominand polycystic kidney disease (ADPKD) is one of the most common genetic diseases in humans and accounts for 8-10% of end-stage renal failure. The disease is caused by mutations in at least three different genes. About 85% of families with ADPKS have a mutation in a gene (PKD1) on chromosome 16p, whereas 10-15% have a mutation in a gene (PKD2) on chromosom 4q. In a few families, a third gene (PKD3) of unkonown location appears to be involved. The purpose of this study was to determine the genotype of Icelandic families with ADPKD.

MATERIAL AND METHODS

We isloated DNA from 229 family members and generated genotypes for polymorphic markers with conventional methods. Linkage analysis and haplotype analysis weere performed in 14 ADPKD families, employing merkers from the PKD1 and PKD2 regions.

RESULTS

The abnormal gene could be located in 13 families. Eleven families demonstrated linkage to the PKD2 locus. Comparison of the haplotypes of the PKD1 families indicates that nine different mutations cause ADPKD1 in Iceland, including one de novo mutation. The two ADPKD2 families each have a distinct haplotype. Thererfor, at least 11 different mutations cause ADPKD in Icelnad. In cooperation with Dutch scientists, one mutation in the PKD2 gene was defined, a 16 bp deletion of a spice site between intron 1 and exon 2.

CONCLUSIONS

Our results demonstrate marked genetic heterogeneity of ADPKD in the Icelandic population. As expected, most of the families have evidence for mutation in the PKD1 gene. The stage has been set for future work, which will focus on detecting mutations in the PKD genes and defining the correlation between mutations and phenotype of the disease.

[Treatment of end-stage renal disease in Iceland 1968-1997 heart disease in Iceland?]

OBJECTIVE

Renal replacement therapy for end-stage renal disease (ESRD) jas been provided in Iceland since 1968 when hemodialysis was begun. Kidney transplantation in Iceland patients has benn performed abroad since 1970 mainly in Copenhagen, Gothenburg and Boston. The purpose of theis retrospective study was to determine the changes in incidencs, prevalence, and outcome of ESRD treatment during the period 1968-1997 and compare the results with other ESRD programs, mainly in the Nordic countries.

MATERIAL AND METHODS

Included in this study were all patients who began renal replacement therapy for ESRD during the study period and remained on therapy for at least six weeks. Data were obtained from the registry of ESRD, compiled by the Dialysis Service of the National University Hospital. The data were used to determine the annual incidence and prevalence of treated ESRD. Changes in parameters, such as age at the beginning of renal replacement therapy, gender distribution, causes of ESRD, treatment modalities, and survival were evaluated. Annual mortality rate was calculated as deaths per 100 life-years. Comparison of means was done by the twö sample t-test, survival was estimated by the Kaplan-Meier method and survival differences weere determined with the Mantel-Cox test.

RESULTS

A total of 201 patients began therapy for ESRD during this 30 year period. The number of patients beginning renal replacement therapy in each of the three consecutive decades was 27, 59 and 115, respectively, which corresponds to 12.8, 25.1 and 44 per million population per year. The mean age rose throughout hte study period nad was 54.8 in the final decade. The prevalence per million population was 72 in 1977, 182 in 1987 nad 356 in 1997. Diabetic nephropathy was not observed as a cause of ESRD until the last decade when it accounted for 12% of new patiens. Hemodialysis was the sole dialysis modality undtil 1985. Peritoneal dialysis has since provided approximately one third of the dialysis treatment. The number of renal transplants was 13, 30 and 58 for each decade, respectively. At the end of 1997 htere were 59 functioning allografts and of these 45 were from living donors. Patients with a functioning allograft were 70% of all ESRD patients at the end of 1997. Allografts came predominantly from cadveric donors during the first two decades but living donors were 65% in the final decade. The five year survival of transplanted patients (81%) was markedly superior to that of dialyzed patients (16%). The annual mortality rate declined for the whole period, during the last decade it was 10.7 per 100 life-years for all patients, 27.9 for hemodialysis patients, 15.3 for peritonial dialysis patients and 2.1 for transplanted patients. Death was mainly from cardiovascular causes and infections.

CONCLUSIONS

There has been marked increase in the incidence and prevalence of treated ESRD in Iceland during the last 30 years. However, the incidence is low compared to the other Nordic countries, mainly as a rresult of low incidence of ESRD due to glomerulonephritis and diabetic nephropathy. Nearly half the ESRD population has recieved a renal transplant. Only Norway has a higher prevalence of transplanted patients among the ESRD pool. The percentage of living donor grafts among the transplanted patients is the highest the auhtors are aware of. Five year patient survival and renal allograft survival in Iceland were comparable to other countries.

Organ exchange in the Nordic countries

Scandiatransplant is an organ exchange organisation founded in 1969. It serves a population of 23 million inhabitants in the five Nordic countries; Iceland, Norway, Sweden, Finland and Denmark. Scandiatransplant maintains a common central waiting list for all Nordic patients waiting for necro-organ transplantation. The waiting lists are maintained on a central computer by each of the eleven transplant centres in the organisation. The number of necro-organ donors in Scandiatransplant is about 340-375 yearly, corresponding to 15-16 donors per million population (PMP) per year. Since the foundation, a total of 14,500 necro-kidney transplants have been performed, and the number of transplants with extrarenal organs is steadily increasing. Presently, about 7-8 liver transplants PMP are being performed, and the heart transplant activity amounts to about 5 PMP. The supreme authority of Scandiatransplant is the Council of Representatives, in which each transplant centre is represented by one or more professionals who are clinically active in organ transplantation. The responsibility for day-to-day operations lies with the Board which has one member appointed by each of the five Nordic countries and a chairman elected by the Council. The activities of Scandiatransplant are financed exclusively by the participating centres.

Scandiatransplant: organ transplantation in the Nordic countries 1996

The Nordic collaboration in organ transplantation was initiated nearly 30 years ago in the frame of Scandiatransplant. With a recent formalization of its structure, Scandiatransplant has become a modern organ exchange organization. The increasing activities of Scandiatransplant clearly reflect the continuously growing need for a close and firm Nordic collaboration in the transplantation field, for the benefit of the numerous patients waiting for an organ transplant.

[Peritonitis associated with peritoneal dialysis.]

Continuous ambulatory peritoneal dialysis (CAPD) is now a recognised treatment for end stage renal disease. An estimated number of 27.000 patients was being treated by CAPD world-wide in the year 1985. The most important complication is infection, peritonitis. The CAPD program started in Iceland in April 1985 at the dialysis department of the National University Hospital. The aim of this study was to estimate the incidence of infection associated with peritoneal dialysis during the first five years. All positive cultures of peritoneal dialysates from the Department of Bacteriology, and the hospital records of patients on CAPD, during the time period 12.04.1985 to 12.04.1990, were studied retrospectively. CAPD was considered started as soon as the peritoneal catheter had been inserted. Peritonitis was considered to be present when the white blood cell count was > 100/ul or there were clinical signs of infection together with a positive culture from the dialysate. During the study period 27 patients were treated by CAPD for 609.6 treatment months. Peritonitis was diagnosed 83 times in 18 of these patients, giving an incidence of 1.63/treatment year. The most common cause was Staphylococcus aureus, which was isolated 35 times (42%). Other causative organisms were: 17 coagulase negative staphylococci (21%), three Gram negative rods (4%), one yeasts and three mixed cultures. In 12 (14%) of the peritonitis episodes, no organisms were isolated. Admission to hospital was considered necessary in 74% of the episodes. One patient died of peritonitis. Studies have demonstrated various infection rates (0.23-6.3 infections/year), but has usually been between 0.8 and 1.2 infections/year. It is of interest to note that the most common causative organism in this study was S. aureus, as opposed to coagulase negative staphylococci, that have normally been the most prevalent. S. aureus usually causes tunnel infections, that are difficult to clear, without removing the catheter. This study demonstrates an above average prevalence of infection, which should prompt a reevaluation of the current management protocols.

Icelandic families with autosomal dominant polycystic kidney disease: families unlinked to chromosome 16p13.3 revealed by linkage analysis

We have mainly used 3 highly polymorphic DNA markers, 3'HVR (D16S85), 16AC2.5 (D16S291) and SM7 (D16S283), flanking the PKD1 region on chromosome 16p13.3 to establish linkage status in seven Icelandic families with autosomal dominant polycystic kidney disease (ADPKD). In four families, the disease locus is in the PKD1 region, and three families are "unlinked" to chromosome 16p13.3. In one of the "unlinked" families, the disease locus is excluded from a part of the long arm of chromosome 2, and we support a theory of more than 2 loci being responsible for ADPKD. Our data confirm the location of the locus YNH24 (D2S44) to chromosome 2q13-q24.

A case of calciphylaxis. Case report

A young woman on hemodialysis with hyperparathyroidism suddenly developed areas of skin necrosis caused by arterial calcification. Parathyroidectomy apparently arrested this process. Seven months after cadaver kidney transplantation, following reparation of a graft artery stenosis, necrosis spread anew from the wound gradually extending to large areas. The patient died and autopsy revealed calcification in many internal organs. The case fits the description of systemic calciphylaxis a syndrome now described in humans but originally experimentally induced in rats.

Persistent water diuresis in renal amyloidosis. A case report

A 67-year-old male with previous history of osteomyelitis presented with persistent thirst and polyuria. His urine remained hyposmolar to plasma after overnight fasting and administration of pitressin. Biopsy and postmortem examination revealed renal amyloidosis with involvement of many glomeruli and smaller vessels. Amyloid was also found in the medulla, particularly around the collecting tubules. It is suggested that amyloid interfered directly with diffusion of water through the walls of the collecting tubules.