Lung Transplantation using Allografts with more than 8 hours
Six hours was historically regarded as the limit of acceptable ischemic time for lung allografts. This study finds that the use of lung allografts with a “long” ischemic time ≥ 8 hours was associated with acceptable outcomes.

Patients who underwent primary isolated bilateral lung transplantation 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) versus ?8 hours (long). Perioperative outcomes and post-transplant survival were compared between groups.

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.

In a modern cohort, the use of lung allografts with a “long” ischemic time ≥8 hours was associated with acceptable perioperative outcomes and post-transplant survival.

The Journal of Heart and Lung Transplantation
Source: https://doi.org/10.1016/j.healun.2021.05.008
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