Trial Lecture – time and place
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Adjudication committee
- First opponent: Associate Professor Laurie Snyder, Department of Medicine, Duke University Hospital, USA
- Second opponent: Professor Karl Lemström, Helsinki University Hospital, Finland
- Third member and chair of the evaluation committee: Professor Pål Dag Line, Faculty of Medicine, University of Oslo
Chair of the Defence
Associate Professor Kristina Haugaa, Faculty of Medicine, University of Oslo
Principal Supervisor
Associate Professor Are Martin Holm, Faculty of Medicine, University of Oslo
Summary
For some patients with end-stage lung disease, lung transplantation may be the only feasible treatment option. However, the availability of this procedure is highly limited because of the shortage of donor organs. The overarching aim of this thesis was to provide insight on how to manage this valuable resource in a fair way with the highest possible benefit.
A large body of literature has demonstrated that inflammation in the donor may reduce organ quality and recipient outcome. Furthermore, measures to attenuate inflammation may increase organ quality and recipient survival. We investigated how the inflammatory response in brain dead donors was modulated by the procurement surgery, and found that the levels of several inflammatory biomarkers were increased during the recovery procedure. Notably, organ recovery is the last time-period where the organs are exposed to the inflammatory environment in the donor, and further studies should explore whether this inflammation could be reduced in order to reduce organ immunogenicity before implantation. The donor acceptability criteria have been debated for the last three decades, and have been gradually been expanded to increase the donor pool. We investigated how donor age affects lung recipient outcome, and found that recipients with cystic fibrosis had reduced survival when receiving organs from donors older than 55 years. Recipients with other diagnoses, however, did not seem to be negatively affected when receiving older organs. This may imply that overall survival after lung transplantation could be improved if allocation algorithms are optimized. Last, we investigated the performance of the Scandinavian Urgent Lung Allocation System (ScULAS), which is a system to allocate donor organs to patients that are critically ill. We found that younger patients and patients with suppurative lung disease more commonly were given urgent status. Patients given urgent status were rapidly transplanted. Still, the waiting list mortality among urgent patients was higher than among patients on the regular waiting list. Notably, urgent patients who died while waiting for an organ often had characteristics that were incompatible with the majority of the donor pool. Patients who received urgent status had slightly inferior survival, plausibly because a larger proportion required use of extracorporeal membrane oxygenation (ECMO) as bridge to transplantation.
Additional information
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