Does donor organ ischemia over four hours affect long-term survival after lung transplantation?
BACKGROUND
Lung transplantation is currently limited by a donor shortage and the need for a short organ ischemic time. The purpose of this analysis was to evaluate prolonged donor organ ischemia and its effect on overall survival.


METHODS
We conducted a retrospective analysis of 83 patients undergoing single (n = 62) or bilateral sequential lung transplantation (n = 21) from June 1, 1989, through July 31, 1994. All allografts were flushed with modified EuroCollins solution at 4 degrees C and stored in cold saline solution. Ischemic time was measured from aortic crossclamping at organ procurement to reperfusion. Ischemic times were divided into three groups: group I < 240 minutes (n = 39), group II 240 to 360 minutes (n = 36), and group III > 360 minutes (n = 8). Ischemic times ranged from 97 to 708 minutes (median, 245 minutes; mean, 252 minutes). Bilateral sequential and single lung transplantations were considered together.


RESULTS
Actuarial survival was not significantly different among groups (p = 0.09). We found no significant difference in time spent in the intensive care unit (p = 0.27) or in total hospital stay (p = 0.57) after transplantation, in forced expiratory volume in 1 second at 1 month after transplantation (p = 0.74), or in the number of acute rejection episodes (p = 0.65). In addition, length of follow-up was similar among groups (p = 0.24).


CONCLUSIONS
Prolonged donor allograft ischemic times were not associated with an adverse effect on survival. The use of allografts with ischemic times through 6 hours achieved acceptable 2-year survival rates after transplantation. The use of donor organs with prolonged ischemic times should prompt the United Network for Organ Sharing to move toward better allocation of donor organs.
Kshettry
V R
VR
Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis 55455, USA.
Kroshus
T J
TJ
Burdine
J
J
Savik
K
K
Bolmon
R M
RM
D000206:Actuarial Analysis; D000328:Adult; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D014021:Tissue Preservation; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome