Long-term Survival After Lung Transplantation is Closely Related to Graft Ischemic Time
Apr 1, 2005 - 9:36:00 AM
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We have found that, in patients who underwent single lung transplantation and bilateral lung transplantation, the relationship between graft ischemic time and the relative risk of death was of cubic form. In other words, although patients who undergo lung transplantation experienced a slight increase in mortality risk when graft ischemic time increases from 1 to 4 hours, there is a rapid increase in the relative risk of death when graft ischemic time is longer than 6 hours.
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By American Thoracic Society,
[RxPG] Based on a study of 752 French patients who underwent either lung or heart-lung transplantation, investigators revealed a close relationship between graft ischemic time and long-term survival after single or double lung transplantation.
Writing in the first issue for April 2005 of the American Thoracic Societys peer-reviewed American Journal of Respiratory and Critical Care Medicine, Gabriel Thabut, M.D., of the Service de Pneumologie et Réanimation at the Hôpital Beaujon in Clichy, France, along with 14 associates, defined graft ischemic time as the interval between the application of the aortic cross-clamp during donor organ removal and the reperfusion (restoration of blood flow) in the graft of the recipient.
According to the authors, a cutoff time of 330 minutes was found to best discriminate between long-term survivors and non-survivors. The median time for the entire group in the transplant study was 240 minutes. Results were unaffected by the organ preservation fluid used.
The expected graft ischemic time should be incorporated in the decision-making process at the time of graft acceptance, said Dr. Thabut.
However, he noted that the effect of graft ischemic time on the relative risk of death seemed to peak in the first year after lung transplantation and to wear off quickly thereafter.
In addition to calculating graft ischemic time, the investigators also measured postoperative gas exchange as a surrogate of early graft function.
Patient survival during the study period (January 1987 to December 1998) at the seven French transplant centers which were involved in the study ran 84.2 percent at day 30, 63.3 percent at 1 year, 45.9 percent at 3 years and 38.1 percent at 5 years.
We have found that, in patients who underwent single lung transplantation and bilateral lung transplantation, the relationship between graft ischemic time and the relative risk of death was of cubic form, said Dr. Thabut. In other words, although patients who undergo lung transplantation experienced a slight increase in mortality risk when graft ischemic time increases from 1 to 4 hours, there is a rapid increase in the relative risk of death when graft ischemic time is longer than 6 hours.
In an editorial commenting on the study in the same issue, Jason D. Christie, M.D., M.S., of the University of Pennsylvania School of Medicine in Philadelphia, notes that Dr. Thabut and colleagues had provided an important contribution to understanding the effect of longer ischemic times on early oxygen exchange and mortality after lung transplantation. He points out that the authors should be commended on their careful statistical methodology, which sets the standard for handling of the ischemic time variable in future studies.
He writes: The report of Thabut and colleagues also may have important clinical ramifications. In their study, 153 subjects out of 752 had an ischemic time greater than 6 hours. As the authors point out in their discussion, in regions where ischemic time can be estimated and is often above this threshold, the decision of the match of patient to donor may be impacted by anticipated ischemic reperfusion injury. Alternately, these findings may be reassuring for other centers where ischemic time is usually below 5 hours. The findings also suggest that transportation of organs over large distances with resultant prolonged ischemic time should not be performed routinely.
Dr. Christie notes that despite the clear strengths of the study, the findings should be interpreted with some caution, given that all data was collected before 1998 and much has changed in clinical lung transplantation since that time.
He points out that confirmation of these findings in other, more modern populations should be performed before modifying clinical practice.
Publication:
First issue for April 2005 of the American Thoracic Societys peer-reviewed American Journal of Respiratory and Critical Care Medicine
On the web:
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Additional information about the news article
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The American Thoracic Society, founded in 1905, is an independently incorporated, international, educational and scientific society which focuses on respiratory and critical care medicine. Today, the Society has approximately 13,500 members, 25 percent of whom are from outside the U.S. The Society's members help prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy. The Society's long-range goal is to decrease morbidity and mortality from respiratory disorders and life-threatening acute illnesses.
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