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Graft Ischemic Time and Outcome of Lung Transplantation

A Multicenter Analysis

Division of Pulmonary Medicine and Thoracic Surgery, Beaujon Hospital, Clichy; Division of Thoracic Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson; Division of Thoracic Surgery, Haut L'Evêque Hospital, Bordeaux; Division of Pulmonary Medicine and Intensive Care Unit, Foch Hospital, Suresnes; Division of Pulmonary Medicine, Louis Pradel Hospital, Lyon; Division of Pulmonary Medicine and Thoracic Surgery, Laënnec Hospital, Nantes; Division of Pulmonary Medicine and Thoracic Surgery, Albert Michalon Hospital, Grenoble; and Division of Thoracic Surgery, Ste. Marguerite Hospital, Marseille, France

Correspondence and requests for reprints should be addressed to Gabriel Thabut, M.D., Service de Pneumologie et Réanimation, Hôpital Beaujon, 100 avenue du Général Leclerc, 92110 Clichy, France. E-mail: gabriel.thabut{at}bjn.ap-hop-paris.fr

Rationale: 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. Objectives: To investigate the relationship between graft ischemic time and (1) early graft function and (2) long-term survival after lung transplantation. Measurements and main 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.

Key Words: lung transplantation • prognosis • acute lung injury • reperfusion injury

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