Time to extubation for lung transplant recipients represents a pragmatic end-point to guide the development of prognostic tests

The field of transplantation would benefit from the integration of advanced precision medicine tech-niques. Although predictive tests for lung transplantation require a well-defined clinical end-point, there exists no consensus regarding which outcomes are optimal end-points for these purposes. While many possible candidate end-points exist, we propose that time-to-extubation is an optimal end-point for prognostic tests because of its: clinical relevance; objectiveness; stability over time; and association with healthcare expenditure. Herein, we describe the rationale for this selection and present the lim-itations of alternative outcomes for this purpose. Using a 72-hour cut-off, time to extubation correlated well with Primary Graft Dysfunction Grade 3, intensive care unit and hospital length of stay, and a greater than 2-fold increase in healthcare cost ratios. Given that time-to-extubation is an objective measure that is readily measured by all lung transplant centers, this metric represents a preferred primary end-point for prognostic tests developed for lung transplantation. J Heart Lung Transplant 2023;42:1515-1517 (c) 2023 International Society for Heart and Lung Transplantation. All rights reserved.