title: Association Between Prolonged Graft Ischemia and Primary Graft Failure or Survival Following Lung Transplantation.
abstract: OBJECTIVE
  The effect of prolonged graft ischemia (≥6 hours) on outcomes following lung transplantation is controversial.
  
  
  OBJECTIVE
  To evaluate the effect of prolonged total graft ischemia times on long-term survival rates and the development of primary graft failure (PGF) following lung transplantation.
  
  
  METHODS
  In this retrospective study, the United Network for Organ Sharing database was queried for adult patients who underwent lung transplantation from May 1, 2005, through December 31, 2011. Primary stratification by the presence of prolonged graft ischemia was performed. Kaplan-Meier estimates at 1 and 5 years were used to compare survival in the 2 cohorts. A multivariable Cox proportional hazards regression model was constructed to identify predictors of 1- and 5-year mortality. A risk-adjusted predictive model for the development of PGF was formulated in a similar fashion.
  
  
  METHODS
  The primary outcome of interest was 1- and 5-year survival. Secondary outcomes included PGF and other postoperative events, such as renal failure, biopsy-proven rejection, and stroke.
  
  
  RESULTS
  Of the 10,225 patients who underwent lung transplantation, 3127 (30.6%) had allografts exposed to prolonged ischemia. There was no difference in survival at 1 (83.6% [95% CI, 82.3%-84.9%] vs 84.1% [95% CI, 83.3%-85.0%]; P = .41) or 5 (52.5% [95% CI, 51.0%-54.0%] vs 53.5% [95% CI, 51.3%-55.6%]; P = .82) years between patients who received grafts that were or were not exposed to ischemia that lasted 6 hours or more, respectively. Prolonged graft ischemia did not independently predict 1- or 5-year mortality or the development of PGF (odds ratio, 1.11; 95% CI, 0.88-1.39; P = .37). Furthermore, prolonged ischemia did not independently predict 1-year (hazard ratio, 1.09; 95% CI, 0.97-1.22; P =.15) or 5-year (hazard ratio, 1.05; 95% CI, 0.98-1.14; P =.18) mortality or the development of PGF (odds ratio, 1.11; 95% CI, 0.88-1.39; P =.37).
  
  
  CONCLUSIONS
  No association was found between prolonged total graft ischemia times and primary graft failure or survival following lung transplantation. Given the scarcity of organs and the paucity of suitable recipients, prolonged ischemia time should not preclude transplantation. It is, therefore, reasonable to consider extending the accepted period of ischemia to more than 6 hours in certain patient populations to improve organ use.
authors: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors: Joshua C
authors: JC
authors: Grimm
authors: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors: Vicente
authors: V
authors: Valero
authors: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors: Arman
authors: A
authors: Kilic
authors: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors: Jonathan T
authors: JT
authors: Magruder
authors: Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: Christian A
authors: CA
authors: Merlo
authors: Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors: Pali D
authors: PD
authors: Shah
authors: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland.
authors: Ashish S
authors: AS
authors: Shah
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult