title: Graft ischemic time and outcome of lung transplantation: a multicenter analysis.
abstract: BACKGROUND
  The effect of graft ischemic time on early graft function and long-term survival of patients who underwent lung transplantation remains controversial. Consequently, graft ischemic time has not been incorporated in the decision-making process at the time of graft acceptance.
  
  
  OBJECTIVE
  To investigate the relationship between graft ischemic time and (1) early graft function and (2) long-term survival after lung transplantation.
  
  
  RESULTS
  The data from 752 patients who underwent single lung transplantation (n = 258), bilateral lung transplantation (n = 247), and heart-lung transplantation (n = 247) in seven French transplantation centers during a 12-year period were reviewed. Independent data quality control was done to ensure the quality of the collected variables. Mean graft ischemic time was 245.8 +/- 96.4 minutes (range 50-660). After adjustment on 11 potential confounders, graft ischemic time was associated with the recipient Pa(O2)/FI(O2) ratio recorded within the first 6 hours and with long-term survival in patients undergoing single or double lung transplantation but not in patients undergoing heart-lung transplantation. The relationship between graft ischemic time and survival appears to be of cubic form with a cutoff value of 330 minutes. These results were unaffected by the preservation fluid employed.
  
  
  CONCLUSIONS
  The results of this large cohort of patients suggest a close relationship between graft ischemic time and both early gas exchange and long-term survival after single and double lung transplantation. Such relationship was not found in patients undergoing heart-lung transplantation. The expected graft ischemic time should be incorporated in the decision-making process at the time of graft acceptance.
authors.affiliation: Division of Pulmonary Medicine and Thoracic Surgery, Beaujon Hospital, Clichy, France. gabriel.thabut@bjn.ap-hop-paris.fr
authors.forename: Gabriel
authors.initials: G
authors.lastname: Thabut
authors.forename: Hervé
authors.initials: H
authors.lastname: Mal
authors.forename: Jacques
authors.initials: J
authors.lastname: Cerrina
authors.forename: Philippe
authors.initials: P
authors.lastname: Dartevelle
authors.forename: Claire
authors.initials: C
authors.lastname: Dromer
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Velly
authors.forename: Marc
authors.initials: M
authors.lastname: Stern
authors.forename: Philippe
authors.initials: P
authors.lastname: Loirat
authors.forename: Guy
authors.initials: G
authors.lastname: Lesèche
authors.forename: Michelle
authors.initials: M
authors.lastname: Bertocchi
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Mornex
authors.forename: Alain
authors.initials: A
authors.lastname: Haloun
authors.forename: Philippe
authors.initials: P
authors.lastname: Despins
authors.forename: Christophe
authors.initials: C
authors.lastname: Pison
authors.forename: Dominique
authors.initials: D
authors.lastname: Blin
authors.forename: Martine
authors.initials: M
authors.lastname: Reynaud-Gaubert
mesh_terms: D000328:Adult; D017677:Age Distribution; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000175:diagnosis*; D008168:Lung / Q000098:blood supply*; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D011336:Probability; D015427:Reperfusion Injury / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors