Influence of graft ischemic time on outcomes following lung transplantation.
BACKGROUND
Reperfusion injury is the most common cause of early mortality following lung transplantation. Although cold graft ischemic time has been reported to influence this injury, some lung grafts with short ischemic times develop significant reperfusion injury, whereas other grafts with more prolonged ischemic times do not develop injury. Our hypothesis was that ischemic time did not significantly influence reperfusion injury or other outcomes following lung transplantation.


METHODS
Data on 136 patients who had lung transplantation over a 10 year period was used for analysis.


RESULTS
Cold graft ischemic time > or = 6 hours did not increase the risk of reperfusion injury, acute rejection, cytomegalovirus infection, bacterial or fungal pneumonia, bronchiolitis obliterans syndrome, 1-month mortality, 1-year mortality, or 5-year mortality compared with ischemic times of either < 4 hours or 4 to 6 hours. The incidence of reperfusion injury was at least 20% for each time group.


CONCLUSIONS
At least 20% of all patients will develop reperfusion injury regardless of cold graft ischemic time. Prolonged ischemic times up to 8 hours do not result in a significant increase in adverse short-term, intermediate, or long-term outcomes. Cautious extension of ischemic time beyond the current target of 4 to 6 hours may be warranted for geographic expansion of the donor lung pool.
Fiser
S M
SM
Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
Kron
I L
IL
Long
S M
SM
Kaza
A K
AK
Kern
J A
JA
Cassada
D C
DC
Jones
D R
DR
Robbins
M C
MC
Tribble
C G
CG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015925:Cryopreservation; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006801:Humans; D008168:Lung / Q000098:blood supply*; D016040:Lung Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology / Q000401:mortality; D009926:Organ Preservation; D015427:Reperfusion Injury / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate