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Published ahead of print on January 21, 2005, doi:10.1164/rccm.200409-1248OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 7, April 2005, 786-791

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Submitted on September 24, 2004
Accepted on January 5, 2005

Graft Ischemic Time and Outcome of Lung Transplantation

Gabriel Thabut1*, Herve Mal1, Jacques Cerrina2, Philippe Dartevelle2, Claire Dromer3, Jean-Francois Velly3, Marc Stern4, Philippe Loirat4, Guy Leseche5, Michelle Bertocchi6, Jean-Francois Mornex6, Alain Haloun7, Philippe Despins7, Christophe Pison8, Daniel Blin8, and Martine Reynaud-Gaubert9

1 Division of Pulmonary Medicine, Beaujon Hospital, Clichy, France, 2 Division of Thoracic Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France, 3 Division of Thoracic Surgery, Haut L' Eveque Hospital, Bordeaux, France, 4 Division of Pulmonary Medicine and Intensive Care Unit, Foch Hospital, Suresnes, France, 5 Division of Thoracic Surgery, Beaujon Hospital, Clichy, France, 6 Division of Pulmonary Medicine, Louis Pradel Hospital, Lyon, France, 7 Division of Pulmonary Medicine and Thoracic Surgery, Laennec Hospital, Nantes, France, 8 Division of Pulmonary Medicine and Thoracic Surgery, Albert Michalon Hospital, Grenoble, France, 9 Division of Thoracic Surgery, Ste Marguerite Hospital, Marseille, France

* To whom correspondence should be addressed. 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; (2) long-term survival following 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 min (range 50-660). After adjustment on 11 potential confounders, 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 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 min. 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 following 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, ischemia




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