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PhD ceremony Ms. C. Van De Wauwer: Selection, preservation and evaluation of lungs from donors after circulatory death

When:Mo 31-03-2014 at 14:30
Where:Academiegebouw, Broerstraat 5, Groningen

PhD ceremony: Ms. C. Van De Wauwer

Dissertation: Selection, preservation and evaluation of lungs from donors after circulatory death

Promotor(s): prof. M. Mariani, prof. D. van Raemdonck

Faculty: Medical Sciences

Lung transplantation is a life saving treatment for well selected patients with benign end-stage pulmonary disease such as emphysema, lung fibrosis, cystic fibrosis or pulmonary hypertension. One of the major limitations of this treatment is the donor organ shortage. This resulted in a renewed interest in the use of organs harvested after circulatory arrest, the so called donation after circulatory death (DCD) donors. Nevertheless, there are several concerns regarding the use of DCD lungs.

The aim of this thesis was to address the concerns regarding residual microthrombi, influence of mode of death on graft performance and the selection and preservation of lungs from DCD. From the experimental part we can conclude that retrograde flush in controlled and uncontrolled DCD lungs leads to reduced pulmonary vascular resistance. In addition, it is not necessary to use heparin in the case of uncontrolled DCD lungs. Long periods of hemodynamic instability after switch-off can damage the lung. Further consideration should be given in the clinical setting. A situation of resuscitation in combination with warm ischemia leads to damage. The occurrence of pulmonary edema was associated with a decrease in the compliance and an increase in airway pressure before there was a visible decrease of the PO2. In the clinical part of the thesis, we described our experience with the use of DCD lungs and we describe a case of a patient who was successfully transplanted with conditioned DCD lungs.

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