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The role of early management and hormone replacement therapy in potential heart and lung donors

Venkateswaran, R.V. (2010)
M.D. thesis, University of Birmingham.

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Abstract

Heart and lung transplantation activity is frustrated by the lack of availability of donor organs. The haemodynamic, hormonal and inflammatory changes that follow brain stem death leads to donor organ injury. Appropriate donor management is essential to avoid further damage to already injured donor heart and lungs. Hormone replacement therapy with tri-iodothyronine and methylprednisolone in organ donors has been reported to increase the retrieval rate of heart and lungs with improved function. In a prospective, randomised, double blind, controlled trial the role of hormone replacement therapy and early donor management on the donor heart and lung function and their retrieval rate was studied. Heart donor Outcome Early donor management was associated with significant improvement in donor heart function. It may also increase the retrieval rate of hearts for transplantation. However, administration of hormones neither influenced the donor heart function nor the heart retrieval rate. Serial echocardiography guides in identifying suitable donor hearts for transplantation during intensive management. Lung donor outcomes Early donor management was associated with significant increase in lung retrieval rate for transplantation. Despite management donor lung function deteriorated following brain stem death. Hormone replacement therapy did not increase the lung retrieval rate or affect the donor lung function. However, methylprednisolone administration leads to significant reduction in progressive donor lung water accumulation. Measurement of thermodilution lung water index predicted ultimate lung suitability for transplantation and recipient outcome. Conclusion Early donor management is the cornerstone to improve the donor heart function and to increase the lung retrieval rate. It may also increase the heart retrieval rate. Serial transthoracic echocardiography may guide in identifying suitable hearts that respond to donor management.

Type of Work:M.D. thesis.
Supervisor(s):Bonser, Robert Stuart and Coote, John
School/Faculty:Colleges (2008 onwards) > College of Medical & Dental Sciences
Department:Department of Heart and Lung Transplantation, University Hospital Birmingham NHS Foundation Trust Birmingham and Department of Physiology, Medical School
Subjects:RC Internal medicine
Institution:University of Birmingham
ID Code:1156
This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder.
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