Commentary on: Risk of prolonged ischaemic time linked to use of cardio-pulmonary bypass during implantation for lung transplantation in the United Kingdom

The impact of ischemia time on post-operative graft function and long-term survival remains a highly controversial issue in lung transplantation. Although a clear link between ischemic time and outcomes exists for other transplanted organs, including the heart, studies in lung transplantation have shown entirely mixed results. Despite early and continued laboratory evidence that prolonged ischemia is associated with cellular markers of reperfusion injury and graft dysfunction, clinical studies have failed to show consistently worse outcomes in patients receiving lungs with longer ischemic times. Nearly 30 years ago, the group at Pittsburgh published their outcomes in patients with ischemic times greater than or less than 6 hours and found no difference in rates of PGD or survival at 3 years 1 Gammie J.S. Stukus D.R. Pham S.M. et al. Effect of ischemic time on survival in clinical lung transplantation. Ann Thorac Surg. 1999; 68 (2015-9; discussion): 9-20 Abstract Full Text Full Text PDF Scopus (73) Google Scholar . As indicated by the ISHLT registry, allograft ischemic times have gradually increased over the past few decades 2 Chambers D.C. Yusen R.D. Cherikh W.S. et al. The registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult lung and heart-lung transplantation report - 2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017; 36: 1047-1059 Abstract Full Text Full Text PDF PubMed Scopus (392) Google Scholar ; however, the implications of this remain unclear. Early and recent studies showing magnification of cellular damage and inflammation in prolonged ischemic lung grafts remain relevant and should be considered as lung transplantation is perused in lungs with extended ischemic times.