Abstract
Lung transplantation is limited by the shortage of donor organs. This thesis aims to provide insight into a fair and bene-ficial management of donor organs. Donor inflammation before procurement may reduce organ quality and recipient outcome. We found that the procurement surgery further increases this inflammation, which may increase organ im-munogenicity. Targeted anti-inflammatory treatment during surgery should be investigated. Furthermore, we found that recipients with cystic fibrosis had reduced survival when using donors ≥ 55 years, while other recipients did not seem to be negatively affected. Thus, optimized allocation might increase overall survival. Last, we investigated the Scandiatransplant Urgent Lung Allocation System (ScULAS), and found that young patients and patients with suppura-tive lung disease more commonly were given urgent status. The majority of these patients were rapidly transplanted, but waiting list mortality among urgent patients was higher than among regular patients. Patients who received urgent status had inferior survival, and more often required life support before transplantation. These results may support optimization of the ScULAS in the future.
List of papers
Paper I: Auråen H, Mollnes TE, Bjortuft O, Bakkan PA, Geiran O, Kongerud J, Fiane A, Holm AM. Multiorgan procurement increases systemic inflammation in brain dead donors. Clinical Transplantation. 2013;27(4):613-8. DOI: 10.1111/ctr.12175. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/ctr.12175 |
Paper II: Auråen H, Durheim MT, Dellgren G, Hämmäinen P, Larsson H, Geiran O, Lawaetz Schultz HH, Leuckfeld I, Iversen M, Fiane AE, Holm AM. Effect of donor age on outcome of lung transplantation stratified by recipient diagnosis: a Nordic multi-center study. Transplantation (In press). To be published. The paper is not available in DUO awaiting publishing. |
Paper III: Auråen H, Lawaetz Schultz HH, Hämmäinen P, Riise G, Larsson H, Hansson L, Dellgren G, Perch M, Geiran O, Fiane AE, Iversen M, Holm AM. The Urgent Lung Allocation System in the Scandiatransplant Countries. Journal of Heart and Lung Transplantation (In press). To be published. The paper is not available in DUO awaiting publishing. |