Influence of graft ischemic time and donor age on survival after lung transplantation

Background: Increased graft ischemic time and donor age are risk factors fo r early death after heart transplantation, but the effect of these variable s on survival after lung transplantation has not been determined in a large , multinational study. Methods: All recipients of cadaveric lung transplantations performed betwee n October 1, 1987 and June 30, 1997 which were reported to the United Netwo rk for Organ Sharing/International Society for Heart and Lung Transplantati on (UNOS/ISHLT) Registry were analyzed. Patient survival rates were estimat ed using Kaplan-Meier methods. Multivariate logistic regression was used to determine the impact of donor and recipient characteristics on patient sur vival after transplantation. To examine whether the impact of donor age var ied with ischemic time, interactions between the 2 terms were examined in a separate multivariate logistic regression model. Results: Kaplan-Meier survival did not differ according to the total lung g raft ischemia time, but recipient survival was significantly adversely affe cted by young (less than or equal to 10 years) or old (less than or equal t o 51 years) donor age (p = 0.01). On multivariate analysis, neither donor a ge nor lung graft ischemic time per se were independent predictors of early survival after transplantation, except if quadratic terms of these variabl es were included in the model. The interaction between donor age and graft ischemia time, however, predicted 1 year mortality after lung transplantati on (p = 0.005), especially if donor age was greater than 55 years and ische mic time was greater than 6 to 7 hours. Conclusions: Graft ischemia time alone is not a risk factor for early death after lung transplantation. Very young or old donor age was associated wit h decreased early survival, whereas the interaction between donor age and i schemic time was a significant predictor of 1 year mortality after transpla ntation. Cautious expansion of donor acceptance criteria (especially as reg ards ischemic time) is advisable, given the critical shortage of donor lung grafts. J Heart Lung Transplant 1999;18:425-431.