Graft ischemic time and outcome of lung transplantation: a multicenter analysis.
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.
Thabut
Gabriel
G
Division of Pulmonary Medicine and Thoracic Surgery, Beaujon Hospital, Clichy, France. gabriel.thabut@bjn.ap-hop-paris.fr
Mal
Hervé
H
Cerrina
Jacques
J
Dartevelle
Philippe
P
Dromer
Claire
C
Velly
Jean-François
JF
Stern
Marc
M
Loirat
Philippe
P
Lesèche
Guy
G
Bertocchi
Michelle
M
Mornex
Jean-François
JF
Haloun
Alain
A
Despins
Philippe
P
Pison
Christophe
C
Blin
Dominique
D
Reynaud-Gaubert
Martine
M
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