6. Influence of graft ischemic time and geographic distance between donor and recipient on survival in children after lung transplantation

HAYES et al, 2016
J Heart Lung Transplant. 2016 May 27. pii: S1053-2498(16)30143-7. doi: 10.1016/j.healun.2016.05.018. [Epub ahead of print]
Hayes D1, Joy BF2, Reynolds SD3, Tobias JD4, Tumin D5. ( Section of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA. Electronic address: hayes.705@osu.edu.

BACKGROUND:

The optimal ischemic time in pediatric lung transplantation (LTx) is unclear, as recent studies have challenged the relevance of 6 hours as an upper limit to acceptable ischemic time.

METHODS:

Pediatric LTx recipients transplanted between 1987 and 2013 were identified in the United Network for Organ Sharing (UNOS) registry to compare survival according to ischemic time, which was categorized as 6 hours.

RESULTS:

930 patients, all 6 hours (HR = 0.985; 95% CI 0.755 to 1.284; p = 0.909). A
multivariate Cox model confirmed the lowest mortality hazard to be 4 to 6 hours, as compared with 6 hours was associated with increased mortality hazard relative to the 4 to 6 hours (HR = 1.613; 95% CI 1.193 to 2.181; p = 0.002). Supplementary analyses examining geographic distance between donor and recipient identified no association between geographic distance and recipient mortality hazard.

CONCLUSIONS:

An ischemic time of 4 to 6 hours was associated with optimal long-term survival in first-time pediatric LTx recipients, whereas a very short ischemic time of 6 hours were both associated with higher mortality hazard in this population.

Copyright © 2016 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. KEYWORDS: donor; geographic distance; ischemic time; lung transplantation; recipient; survival. PMID:27373823 DOI: 10.1016/j.healun.2016.05.018 [PubMed – as supplied by publisher]