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Lung transplantation using allografts with more than 8 hours of ischemic time: A single-institution experience.

Publication ,  Conference
Halpern, SE; Au, S; Kesseli, SJ; Krischak, MK; Olaso, DG; Bottiger, BA; Haney, JC; Klapper, JA; Hartwig, MG
Published in: J Heart Lung Transplant
November 2021

BACKGROUND: Six hours was historically regarded as the limit of acceptable ischemic time for lung allografts. However, broader sharing of donor lungs often necessitates use of allografts with ischemic time >6 hours. We characterized the association between ischemic time ≥8 hours and outcomes after lung transplantation using a contemporary cohort from a high-volume institution. METHODS: Patients who underwent primary isolated bilateral lung transplantation between 1/2016 and 5/2020 were included. Patients bridged to transplant with extracorporeal membrane oxygenation or mechanical ventilation, and ex-vivo perfusion cases were excluded. Recipients were stratified by total allograft ischemic time <8 hours (standard) vs ≥8 hours (long). Perioperative outcomes and post-transplant survival were compared between groups. RESULTS: Of 358 patients, 95 (26.5%) received long ischemic time (≥8 hours) lungs. Long ischemic time recipients were more likely to be male and have donation after circulatory death donors than standard ischemic time recipients. On unadjusted analysis, long and standard ischemic time recipients had similar survival, and similar rates of grade 3 primary graft dysfunction at 72 hours, extracorporeal membrane oxygenation post-transplant, acute rejection within 30 days, reintubation, and post-transplant length of stay. After adjustment, long and standard ischemic time recipients had comparable risks of mortality or graft failure. CONCLUSIONS: In a modern cohort, use of lung allografts with "long" ischemic time ≥8 hours were associated with acceptable perioperative outcomes and post-transplant survival. Further investigation is required to better understand how broader use impacts post-lung transplant outcomes and the implications for smarter sharing under an evolving national allocation policy.

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Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

November 2021

Volume

40

Issue

11

Start / End Page

1463 / 1471

Location

United States

Related Subject Headings

  • Tissue Donors
  • Time Factors
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Primary Graft Dysfunction
  • North Carolina
  • Middle Aged
  • Male
  • Lung Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
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Halpern, S. E., Au, S., Kesseli, S. J., Krischak, M. K., Olaso, D. G., Bottiger, B. A., … Hartwig, M. G. (2021). Lung transplantation using allografts with more than 8 hours of ischemic time: A single-institution experience. In J Heart Lung Transplant (Vol. 40, pp. 1463–1471). United States. https://doi.org/10.1016/j.healun.2021.05.008
Halpern, Samantha E., Sandra Au, Samuel J. Kesseli, Madison K. Krischak, Danae G. Olaso, Brandi A. Bottiger, John C. Haney, Jacob A. Klapper, and Matthew G. Hartwig. “Lung transplantation using allografts with more than 8 hours of ischemic time: A single-institution experience.” In J Heart Lung Transplant, 40:1463–71, 2021. https://doi.org/10.1016/j.healun.2021.05.008.
Halpern SE, Au S, Kesseli SJ, Krischak MK, Olaso DG, Bottiger BA, et al. Lung transplantation using allografts with more than 8 hours of ischemic time: A single-institution experience. In: J Heart Lung Transplant. 2021. p. 1463–71.
Halpern, Samantha E., et al. “Lung transplantation using allografts with more than 8 hours of ischemic time: A single-institution experience.J Heart Lung Transplant, vol. 40, no. 11, 2021, pp. 1463–71. Pubmed, doi:10.1016/j.healun.2021.05.008.
Halpern SE, Au S, Kesseli SJ, Krischak MK, Olaso DG, Bottiger BA, Haney JC, Klapper JA, Hartwig MG. Lung transplantation using allografts with more than 8 hours of ischemic time: A single-institution experience. J Heart Lung Transplant. 2021. p. 1463–1471.
Journal cover image

Published In

J Heart Lung Transplant

DOI

EISSN

1557-3117

Publication Date

November 2021

Volume

40

Issue

11

Start / End Page

1463 / 1471

Location

United States

Related Subject Headings

  • Tissue Donors
  • Time Factors
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Primary Graft Dysfunction
  • North Carolina
  • Middle Aged
  • Male
  • Lung Transplantation