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Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality.

Publication ,  Journal Article
Hayes, D; Hartwig, MG; Tobias, JD; Tumin, D
Published in: Am J Transplant
January 2017

The influence of prolonged ischemic time on outcomes after lung transplant is controversial, but no research has investigated ischemic time in the context of center volume. We used data from the United Network for Organ Sharing to estimate the influence of ischemic time on patient survival conditional on center volume in the post-lung allocation score era (2005-2015). The analytic sample included 14 877 adult lung transplant recipients, of whom 12 447 were included in multivariable survival analysis. Patient survival was improved in high-volume centers compared with low-volume centers (log-rank test p = 0.001), although mean ischemic times were longer at high-volume centers (5.16 ± 1.70 h vs. 4.83 ± 1.63 h, p < 0.001). Multivariable Cox proportional hazards regression stratified by transplant center found an adverse influence of longer ischemic time at low-volume centers but not at high-volume centers. At centers performing 50 transplants in the period 2005-2015, for example, 8 versus 6 h of ischemia were associated with an 18.9% (95% confidence interval 6.5-32.7%; p < 0.001) greater mortality hazard, whereas at centers performing 350 transplants in this period, no differences in survival by ischemic time were predicted. Despite longer mean ischemic time at high-volume transplant centers, these centers had favorable patient outcomes and no adverse survival implications of prolonged ischemia.

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Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

January 2017

Volume

17

Issue

1

Start / End Page

218 / 226

Location

United States

Related Subject Headings

  • Tissue and Organ Procurement
  • Time Factors
  • Survival Rate
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Lung Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
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Hayes, D., Hartwig, M. G., Tobias, J. D., & Tumin, D. (2017). Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality. Am J Transplant, 17(1), 218–226. https://doi.org/10.1111/ajt.13916
Hayes, D., M. G. Hartwig, J. D. Tobias, and D. Tumin. “Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality.Am J Transplant 17, no. 1 (January 2017): 218–26. https://doi.org/10.1111/ajt.13916.
Hayes D, Hartwig MG, Tobias JD, Tumin D. Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality. Am J Transplant. 2017 Jan;17(1):218–26.
Hayes, D., et al. “Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality.Am J Transplant, vol. 17, no. 1, Jan. 2017, pp. 218–26. Pubmed, doi:10.1111/ajt.13916.
Hayes D, Hartwig MG, Tobias JD, Tumin D. Lung Transplant Center Volume Ameliorates Adverse Influence of Prolonged Ischemic Time on Mortality. Am J Transplant. 2017 Jan;17(1):218–226.

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

January 2017

Volume

17

Issue

1

Start / End Page

218 / 226

Location

United States

Related Subject Headings

  • Tissue and Organ Procurement
  • Time Factors
  • Survival Rate
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Lung Transplantation