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Send to a FriendIschemia-reperfusion injury after lung transplantation increases risk of late bronchiolitis obliterans syndrome. Fiser SM, Tribble CG, Long SM, Kaza AK, Kern JA, Jones DR, Robbins MK, and Kron IL. Ann Thorac Surg 73:1041-1047, 2002.
BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is the most common cause of long-term morbidity and mortality after lung transplantation. Our hypothesis was that early ischemia-reperfusion injury after lung transplantation increases the risk of BOS. METHODS: Data on 134 patients who had lung transplantation between January 1, 1990 and January 1, 2000, was used for univariate and multivariate logistic regression analysis. RESULTS: After lung transplantation, 115 patients (115 of 134, 86%) survived more than 3 months. In that group, 41 patients developed BOS, of which 23 had progressive disease. Univariate analysis revealed that ischemia-reperfusion injury (p = 0.017) and two or more acute rejection episodes (p = 0.032) were predictors of BOS onset, whereas ischemia-reperfusion injury (p = 0.011) and cytomegalovirus infection (p = 0.009) predicted progressive BOS. Multivariate logistic regression analysis showed that ischemia-reperfusion injury was an independent predictor for both BOS development and BOS progression. Two or more acute rejection episodes were also an independent predictor of BOS development, whereas cytomegalovirus infection was an independent predictor of progressive BOS. CONCLUSIONS: Ischemia-reperfusion injury increases the risk of BOS after lung transplantation.
Influence of Graft Ischemia Time on Outcomes Following Lung Transplantation. Fiser SM, Kron IL, Long SM, Kaza KA, Kern JA, Cassada DC, Jones DR, Robbins MC, and Tribble CG. J Heart Lung Tansplant. 20(12):1291-1296, 2001.
Introduction: Reperfusion injury is the most common cause of early mortality following lung transplantation. Although cold graft ischemia time has been reported to influence this injury, some lung grafts with short ischemia times develop significant reperfusion injury while other grafts with more prolonged ischemia times do not develop injury. Our hypothesis was that ischemia time did not significantly influence reperfusion injury or other outcomes following lung transplantation.
Methods: Data on 136 patients who had lung transplantation over a 10 year period was used for analysis.
Results: Cold graft ischemia time ³ 6 hours did not increase the risk of reperfusion injury, acute rejection, cytomegalovirus infection, bacterial or fungal pneumonia, bronchiolitis obliterans syndrome (BOS), 1 month mortality, 1 year mortality, or 5 year mortality compared to ischemia times of either < 4 hours or 4-6 hours. The incidence of reperfusion injury was at least 20% for each time group.
Conclusions: At least 20% of all patients will develop reperfusion injury regardless of cold graft ischemia time. Prolonged ischemia times up to 8 hours do not result in a significant increase in adverse short, intermediate, or long term outcomes. Cautious extension of ischemia time beyond the current target of 4-6 hours may be warranted for geographic expansion of the donor lung pool.
Influence of graft ischemia time on outcomes following lung transplantation. Fiser SM, Kron IL, Long SM, Kaza AK, Kern JA, Cassada DC, Jones DR, Robbins MC, Tribble CG. J Heart Lung Transplant. 20(12):1291-6, 2001.
BACKGROUND: Reperfusion injury is the most common cause of early mortality following lung transplantation. Although cold graft ischemic time has been reported to influence this injury, some lung grafts with short ischemic times develop significant reperfusion injury, whereas other grafts with more prolonged ischemic times do not develop injury. Our hypothesis was that ischemic time did not significantly influence reperfusion injury or other outcomes following lung transplantation. METHODS: Data on 136 patients who had lung transplantation over a 10 year period was used for analysis. RESULTS: Cold graft ischemic time > or = 6 hours did not increase the risk of reperfusion injury, acute rejection, cytomegalovirus infection, bacterial or fungal pneumonia, bronchiolitis obliterans syndrome, 1-month mortality, 1-year mortality, or 5-year mortality compared with ischemic times of either < 4 hours or 4 to 6 hours. The incidence of reperfusion injury was at least 20% for each time group. CONCLUSIONS: At least 20% of all patients will develop reperfusion injury regardless of cold graft ischemic time. Prolonged ischemic times up to 8 hours do not result in a significant increase in adverse short-term, intermediate, or long-term outcomes. Cautious extension of ischemic time beyond the current target of 4 to 6 hours may be warranted for geographic expansion of the donor lung pool.
Reperfusion injury significantly impacts clinical outcome after pulmonary transplantation. King RC, Binns OA, Rodriguez F, Kanithanon RC, Daniel TM, Spotnitz WD, Tribble CG, and Kron IL. Ann Thorac Surg. 69:1681-85, 2000.
Background: Reperfusion injury after pulmonary transplantation can contribute significantly to postoperative pulmonary dysfunction. We hypothesized that posttransplantation reperfusion injury would result in an increase in both in-hospital mortality and morbidity. We also hypothesized that the incidence of reperfusion injury would be dependent upon the cause of recipient lung disease and the interval of donor allograft ischemia.
Methods: We performed a retrospective study of all lung transplant recipients at our institution from June 1990 until June 1998. One hundred patients received 120 organs during this time period. We compared two groups of patients in this study: those experiencing a significant reperfusion injury (22%) and those who did not (78%).
Results: In-hospital mortality was significantly greater in patients experiencing reperfusion injury (40.9% versus 11.7%, p < 0.02). Posttransplantation reperfusion injury also resulted in prolonged ventilation (393.5 versus 56.8 hours, p < 0.001) and an increased length of stay in both the intensive care unit (22.2 versus 10.5 days, p < 0.01) and in the hospital (48.8 versus 25.6 days, p < 0.03).
The incidence of reperfusion injury could not be attributed to length of donor organ ischemia (221.5 versus 252.9 minutes, p < 0.20). The clinical impact of reperfusion injury was significantly greater in patients undergoing transplantation for preexisting pulmonary hypertension (6/14) than those with chronic obstructive pulmonary disease or emphysema alone (6/54) (42.9% versus 11.1%, p < 0.012).
Conclusions: Clinically significant pulmonary reperfusion injury increased in-hospital mortality and morbidity resulting in prolonged ventilation, length of stay in the intensive care unit, and cost of hospitalization. The incidence of reperfusion injury was not dependent upon the duration of donor organ ischemia but increased with the presence of preoperative pulmonary hypertension. These findings suggest that recipient pathophysiology and donor allograft quality may play important roles in determining the incidence of reperfusion injury.ecipient pathophysiology