Association between Allograft Ischemic Time and Adverse Outcomes Following Lung Transplantation

Purpose Efforts to increase the number of viable donors, such as ex vivo lung perfusion and donation after circulatory death, are likely to significantly alter allograft ischemic time distributions. As such, understanding the impact allograft ischemia has on short and long-term outcomes will be key in determining best practices going forward. Methods We conducted an ISHLT database study of adult bilateral lung transplant recipients between January 1, 2006 and June 30, 2016. We evaluated for an association between first and second lung ischemic time and short- and long-term outcomes post-transplant. We also performed regression modeling to evaluate factors associated with prolonged ischemic time. Results 13,183 recipients were included in the final analysis. Prolonged first but not second lung ischemic time was associated with decreased unadjusted 30-day survival (log-rank p=0.048) and higher rates of treated acute rejection in the first post-transplant year (p Conclusion First allograft ischemic time appears more strongly associated with increased 30-day and 1-year mortality as well as prolonged index hospitalization and increased acute rejection in the first year. This suggests that, in bilateral lung recipients, first lung ischemic time is more clinically relevant to allograft and patient outcomes.