title: Influence of graft ischemic time on survival in children with cystic fibrosis after lung transplantation.
abstract: The influence of graft ischemic time on survival after lung transplantation (LTx) in children with cystic fibrosis (CF) is not well studied.
  
  
  
  The United Network for Organ Sharing (UNOS) database was queried from May 2005 to September 2013 to examine the impact of ischemic time of <4, 4-6, and >6 hr in pediatric LTx recipients with CF.
  
  
  
  One hundred and ninety-nine patients with CF under 18 years of age that were first-time LTx recipients from cadaveric donors were included in the analysis. Compared to 4-6 hr, univariate analysis showed a significant increase in mortality hazard with an ischemic time of <4 hr (HR = 2.407; 95%CI: 1.292, 4.485; P = 0.006) but not >6 hr (HR = 1.350; 95%CI: 0.796, 2.290; P = 0.266). A Kaplan-Meier plot demonstrated the highest survival with 4-6 hr (Log-rank test P = 0.018) of ischemic time. Multivariate Cox model confirmed a significantly higher mortality risk with <4 hr (HR = 2.388; 95%CI: 1.169, 4.764; P = 0.014) and not >6 hr (HR = 1.407; 95%CI: 0.760, 2.605; P = 0.278) in relation to 4-6 hr. Sub-analysis examining ischemic time and the hazard of bronchiolitis obliterans syndrome with death as a competing risk found no significant differences in the hazard of this outcome across the three ischemic time categories.
  
  
  
  Ischemic time of 4-6 hr was associated with the highest long-term survival in first-time pediatric LTx recipients with CF, with ischemic time <4 hr related to diminished survival. Pediatr Pulmonol. 2016; 51:908-913. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Kopp
authors.affiliation: Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio.|Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.|Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Shahid I
authors.initials: SI
authors.lastname: Sheikh
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.|Center for Pediatric Transplant Research, Nationwide Children's Hospital, Columbus, Ohio.|Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Kirkby
mesh_terms: D000293:Adolescent; D001989:Bronchiolitis Obliterans / Q000150:complications; D002648:Child; D050377:Cold Ischemia; D003550:Cystic Fibrosis / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors
keywords: cystic fibrosis; donor; ischemic time; lung transplantation; recipient; survival