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Influence of graft ischemic time on survival in children with cystic fibrosis after lung transplantation
Author(s) -
Hayes Don,
Tumin Dmitry,
Kopp Benjamin T.,
Tobias Joseph D.,
Sheikh Shahid I.,
Kirkby Stephen E.
Publication year - 2016
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23432
Subject(s) - medicine , bronchiolitis obliterans , hazard ratio , proportional hazards model , lung transplantation , transplantation , cystic fibrosis , survival analysis , univariate analysis , surgery , gastroenterology , multivariate analysis , confidence interval
Summary Background The influence of graft ischemic time on survival after lung transplantation (LTx) in children with cystic fibrosis (CF) is not well studied. Methods The 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 >6 hr in pediatric LTx recipients with CF. Results One 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 4–6 hr, univariate analysis showed a significant increase in mortality hazard with an ischemic time of <4 hr (HR = 2.407; 95%CI: 1.292, 4.485; P = 0.006) but not >6 hr (HR = 1.350; 95%CI: 0.796, 2.290; P = 0.266). A Kaplan–Meier plot demonstrated the highest survival with 4–6 hr (Log‐rank test P = 0.018) of ischemic time. Multivariate Cox model confirmed a significantly higher mortality risk with <4 hr (HR = 2.388; 95%CI: 1.169, 4.764; P = 0.014) and not >6 hr (HR = 1.407; 95%CI: 0.760, 2.605; P = 0.278) in relation to 4–6 hr. 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. Conclusions Ischemic time of 4–6 hr was associated with the highest long‐term survival in first‐time pediatric LTx recipients with CF, with ischemic time <4 hr related to diminished survival. Pediatr Pulmonol. 2016; 51:908–913 . © 2016 Wiley Periodicals, Inc.