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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Consultant Marta Farrero, Hospital Clinic de Barcelona, Spain
- Second opponent: Senior Consultant Rune Mo, The University hospital of St. Olav
- Third member and chair of the evaluation committee: Professor Henrik Schirmer, University of Oslo
Chair of the Defence
Professor Emeritus Knut Gjesdal, University of Oslo
Principal Supervisor
Senior Consultant Kaspar Broch, Oslo University Hospital
Summary
Exercise capacity is reduced in heart transplant (HTx) recipients compared to healthy individual. Intravenous iron treatment improves physical capacity in iron deficient patients with heart failure (HF), when iron deficiency (ID) is defined by liberal cut offs compared to the definition used in the general population.
The aim of this PhD thesis was to identify the prevalence of ID in a HTx population and to evaluate the effect of intravenous iron substitution on physical performance in HTx recipients with ID. We also sought to assess if known markers of iron metabolism differed between HTx recipients with ID and healthy individuals.
Patients with ID defined as in HF were recruited to the IronIC trial, a randomised, controlled, double-blind trial, where the effect of a single dose of intravenous iron substitution was compared with placebo. The primary endpoint was the peak oxygen consumption (peakVO2) (ml/kg/min), measured during a cardio-pulmonary exercise test. Biobank samples were analysed to assess important markers of iron homeostasis.
Forty-seven percent had ID as defined in HF. At follow-up, there was no between-group difference in peakVO2 in patients with ID defined this way. However, in a small group of patients with ID as defined in a normal population, peakVO2 was improved after iron treatment. Markers of iron metabolism did not significantly differ between the HTx recipients in the IronIC trial and a healthy control group.
Our results show that ID is prevalent among HTx recipients when defined as in HF. However, intravenous iron therapy did not improve physical capacity and markers of iron metabolism were similar to that of a healthy population. This suggests that in HTx recipients, ID should be defined as in the general population. Iron supplement provided to patients without ID might result in iron overload, which might be harmful. It is important to establish a suitable definition of ID in the HTx population to appropriately provide iron substitution.
Additional information
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