Lung Transplantation Using Allografts With Extreme Ischemic Time: A Single-Institution Experience

Purpose Six hours has historically been regarded as the limit of acceptable ischemic time (IT) for lung allografts. However, smarter sharing of donor lungs often necessitates use of allografts with IT \u003e6 hours. We characterized the association between IT ≥8 hours and outcomes after lung transplantation (LTx) using a contemporary cohort from a high-volume institution. We hypothesized that longer ITs do not predict greater mortality or graft failure. Methods Patients who underwent primary isolated bilateral orthotopic LTx between 1/2016-5/2020 were included. Patients bridged to LTx with ECMO or mechanical ventilation, and ex-vivo perfusion cases were excluded. Recipients were stratified by allograft IT Results Of 358 patients, 95 (26.5%) received IT ≥8h lungs. IT ≥8h recipients were more likely to be male (69.5% vs 54.4%, p=0.01) and have DCD donors (20.0% vs 5.3%, p Conclusion In a modern cohort, use of lung allografts with IT ≥8h was associated with similar perioperative outcomes and post-transplant survival. Further investigation is required to better understand how broader use impacts post-LTx outcomes and the implications for smarter sharing under an evolving national allocation policy.