Effect of ischemic time on survival in clinical lung transplantation

Background. While there is convincing evidence that prolonged ischemic time s correlate with reduced longterm survival in heart transplantation, the ef fect of ischemic time on outcome in clinical lung transplantation remains c ontroversial. To assess the effect of ischemic time on outcomes in lung tra nsplantation, we reviewed our experience. Methods. The study was performed by retrospective chart review. Results. First-time lung transplantation was performed on 392 patients betw een 1988 and 1998. All grafts were flushed with cold crystalloid preservati on solution and stored on ice. Ischemic time data were available for 352 of 392 (90%) patients. Ischemic times were grouped as follows: 0 to 4 hours ( n = 91), 4 to 6 hours (n = 201), more than 6 hours (n = 60). Ischemic time did not correlate with survival: 3-year actuarial survival = 56% (0 to 4 ho urs), 58% (4 to 6 hours), 68% (> 6 hours), p = 0.58. There was no significa nt difference in the incidence of biopsy-proven diffuse alveolar damage in the first 30 days after transplantation (31%, 32%, 38%), episodes of acute rejection in the first 100 days after transplantation (1.9, 1.8, 1.7), dura tion of intubation (median 3, 4, 3 days), or incidence of obliterative bron chiolitis (23%, 28%, 26%) between the three groups (0 to 4 hours, 4 to 6 ho urs, > 6 hours, respectively). A diagnosis of diffuse alveolar damage was a ssociated with a significantly worse outcome (1-year survival = 82% versus 54%, p < 0.0001). Conclusions. In contrast to heart transplantation, pulmonary allograft isch emic time up to 9 hours does not appear to have a significant impact on ear ly graft function or survival. The presence of diffuse alveolar damage on b iopsy early after transplantation does not correlate with prolonged ischemi c time, but is associated with substantially reduced posttransplantation su rvival. (C) 1999 by The Society of Thoracic Surgeons.