Graft Ischemic Time and Outcome of Lung Transplantation

Rationale: The effect of graft ischemic time on early graft function andlong-termsurvivalofpatientswhounderwentlungtransplanta- tion 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 be- tween 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 trans- plantation centersduring a12-year periodwere reviewed.Indepen- dent 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 con- founders, graft ischemic time was associated with the recipient PaO2/FIO2 ratio recorded within the first 6 hours and with long-term survival in patients undergoing single or double lung transplanta- tion 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 relation- ship 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.