PULMONARY ALLOGRAFT ISCHEMIC TIME - AN IMPORTANT PREDICTOR OF SURVIVAL AFTER LUNG TRANSPLANTATION

Background: Traditionally organ availability in human lung transplanta tion has been limited by aiming to keep the graft ischemic time under 6 hours. To maximize organ supply in a country with a widely spread po pulation, we have routinely procured organs beyond this time. Our expe rience outlines the clinical consequences of a prolonged allograft isc hemic time. Methods: Between 1990 and 1994 we performed 106 lung or he art-lung transplantations. The average graft ischemic time was 323 +/- 93 minutes. Lung preservation included a prostacyclin infusion (40 to 80 ng/kg/min for 10 minutes) and cold modified Euro-Collins solution flush. Organs were stored and transported on ice at 6 degrees to 10 de grees C. Graft ischemic time, transplant type, age, gender, cytomegalo virus status, and anesthetic time were subject to multivariate Cox reg ression analysis. Results: Survival and graft ischemic times for heart -lung (n = 38), single lung (n = 33), and bilateral lung transplantati on (n = 35) were not significantly different. Graft ischemic time was an independent predictor of survival (p < 0.01). Subgroup analysis not es the effect to be most pronounced beyond 5 hours (p = 0.02, hazard r atio 3.44, confidence interval 1.12 to 9.8). Conclusions: Pulmonary al lograft ischemic time beyond 5 hours does result in acceptable outcome s although survival is reduced. Attempts should be made to minimize gr aft ischemic times with careful coordination of transport and personne l.