Influence of graft ischemic time on survival in children with cystic fibrosis after lung transplantation

BackgroundThe influence of graft ischemic time on survival after lung transplantation (LTx) in children with cystic fibrosis (CF) is not well studied. MethodsThe United Network for Organ Sharing (UNOS) database was queried from May 2005 to September 2013 to examine the impact of ischemic time of <4, 4-6, and >6hr in pediatric LTx recipients with CF. ResultsOne hundred and ninety-nine patients with CF under 18 years of age that were first-time LTx recipients from cadaveric donors were included in the analysis. Compared to 4-6hr, univariate analysis showed a significant increase in mortality hazard with an ischemic time of <4hr (HR=2.407; 95%CI: 1.292, 4.485; P=0.006) but not >6hr (HR=1.350; 95%CI: 0.796, 2.290; P=0.266). A Kaplan-Meier plot demonstrated the highest survival with 4-6hr (Log-rank test P=0.018) of ischemic time. Multivariate Cox model confirmed a significantly higher mortality risk with <4hr (HR=2.388; 95%CI: 1.169, 4.764; P=0.014) and not >6hr (HR=1.407; 95%CI: 0.760, 2.605; P=0.278) in relation to 4-6hr. Sub-analysis examining ischemic time and the hazard of bronchiolitis obliterans syndrome with death as a competing risk found no significant differences in the hazard of this outcome across the three ischemic time categories. ConclusionsIschemic time of 4-6hr was associated with the highest long-term survival in first-time pediatric LTx recipients with CF, with ischemic time <4hr related to diminished survival. Pediatr Pulmonol. 2016; 51:908-913. (c) 2016 Wiley Periodicals, Inc.