Graft Ischemic Time and Outcome of Lung Transplantation

Thabut, Gabriel; Mal, Hervé; Cerrina, Jacques; Dartevelle, Philippe; Dromer, C.; Velly, Jean-François; Stern, M.; Loirat, Philippe; Lesèche, Guy; Bertocchi, M.; Mornex, Jean‐François; Haloun, A.; Despins, Philippe; Pison, Christophe; Blin, Dominique; Reynaud‐Gaubert, Martine

doi:10.1164/rccm.200409-1248oc

Cited by 190 publications

(111 citation statements)

References 21 publications

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“…We hypothesized a priori that the type of transplant (single vs. double), use of cardiopulmonary bypass (32,33), primary graft dysfunction (PGD) (31), and allograft ischemic time (34,35) would be associated with worse cognitive function after lung transplantation. In addition, we hypothesized that physical therapy, as measured by gain of function after physical therapy and maximal function achieved in those having completed posttransplantation acute rehabilitation at the time of testing, would protect against cognitive decline (36).…”

Section: Candidate Risk Factors For Cognitive Impairmentmentioning

confidence: 99%

“…Two physicians, blinded to the assessment, independently reviewed chest radiographs, with adjudication by a third physician when required as part of the prospective Lung Transplant Outcomes Group cohort study (31,39). Total allograft ischemic time was defined as the time interval (minutes) between aortic crossclamp time during donor harvest and reperfusion in organ recipient; in bilateral lung transplantation, the longer of the two recorded times was defined as the total allograft ischemic time (34).…”

Section: Candidate Risk Factors For Cognitive Impairmentmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

“…We had proposed that allograft ischemic time may result in cognitive decline due to systemic effects of ischemia-reperfusion injury, mediated by oxidative stress and inflammation, which could lead to neuroinflammation (34,35,43,44). Additionally, prolonged allograft ischemic time has been associated with impaired gas exchange (i.e., Pa O 2 /FI O 2 ) immediately postoperatively (34) and impaired longterm survival. Confirmatory studies, designed to examine markers of oxidative stress (34,35), inflammation (e.g., IL-18) (35,(43)(44)(45), and oxygenation postoperatively as potential mediators of the observed relationships between allograft ischemic time, oxygenation, and cognitive function, are required to validate our observations.…”

Section: Original Researchmentioning

confidence: 99%

“…Additionally, prolonged allograft ischemic time has been associated with impaired gas exchange (i.e., Pa O 2 /FI O 2 ) immediately postoperatively (34) and impaired longterm survival. Confirmatory studies, designed to examine markers of oxidative stress (34,35), inflammation (e.g., IL-18) (35,(43)(44)(45), and oxygenation postoperatively as potential mediators of the observed relationships between allograft ischemic time, oxygenation, and cognitive function, are required to validate our observations. Related future studies are required to examine whether the previously identified relationship between prolonged allograft ischemic time and long-term survival (34) is mediated by cognitive impairment and the potential adverse events related to such impairment (i.e., functional impairment, medication nonadherence, infectious complications) (46,47).…”

Section: Original Researchmentioning

confidence: 99%

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Cognitive Function, Mental Health, and Health-related Quality of Life after Lung Transplantation

Cohen

Christie²,

Anderson³

et al. 2014

Annals ATS

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Rationale: Cognitive and psychiatric impairments are threats to functional independence, general health, and quality of life. Evidence regarding these outcomes after lung transplantation is limited.Objectives: Determine the frequency of cognitive and psychiatric impairment after lung transplantation and identify potential factors associated with cognitive impairment after lung transplantation.Methods: In a retrospective cohort study, we assessed cognitive function, mental health, and health-related quality of life using a validated battery of standardized tests in 42 subjects posttransplantation. The battery assessed cognition, depression, anxiety, resilience, and post-traumatic stress disorder (PTSD). Cognitive function was assessed using the Montreal Cognitive Assessment, a validated screening test with a range of 0 to 30. We hypothesized that cognitive function post-transplantation would be associated with type of transplant, cardiopulmonary bypass, primary graft dysfunction, allograft ischemic time, and physical therapy posttransplantation. We used multivariable linear regression to examine the relationship between candidate risk factors and cognitive function post-transplantation.Measurements and Main Results: Mild cognitive impairment (score, 18-25) was observed in 67% of post-transplant subjects (95% confidence interval [CI]: 50-80%) and moderate cognitive impairment (score, 10-17) was observed in 5% (95% CI, 1-16%) of post-transplant subjects. Symptoms of moderate to severe anxiety and depression were observed in 21 and 3% of post-transplant subjects, respectively. No transplant recipients reported symptoms of PTSD. Higher resilience correlated with less psychological distress in the domains of depression (P , 0.001) and PTSD (P = 0.02). Prolonged graft ischemic time was independently associated with worse cognitive performance after lung transplantation (P = 0.001).The functional gain in 6-minute-walk distance achieved at the end of post-transplant physical rehabilitation (P = 0.04) was independently associated with improved cognitive performance post-transplantation.Conclusions: Mild cognitive impairment was present in the majority of patients after lung transplantation. Prolonged allograft ischemic time may be associated with cognitive impairment. Poor physical performance and cognitive impairment are linked, and physical rehabilitation post-transplant and psychological resilience may be protective against the development of long-term impairment. Further study is warranted to confirm these potential associations and to examine the trajectory of cognitive function after lung transplantation.Keywords: lung transplantation; cognitive function; psychological function; quality of life; critical illness

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Section: Candidate Risk Factors For Cognitive Impairmentmentioning

confidence: 99%

Section: Candidate Risk Factors For Cognitive Impairmentmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

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Cognitive Function, Mental Health, and Health-related Quality of Life after Lung Transplantation

Cohen

Christie²,

Anderson³

et al. 2014

Annals ATS

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Prolonged Lung Allograft Ischemia and Posttransplant Outcome

Bharat

2015

JAMA Surg

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Association Between Prolonged Graft Ischemia and Primary Graft Failure or Survival Following Lung Transplantation

et al. 2015

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No association was found between prolonged total graft ischemia times and primary graft failure or survival following lung transplantation. Given the scarcity of organs and the paucity of suitable recipients, prolonged ischemia time should not preclude transplantation. It is, therefore, reasonable to consider extending the accepted period of ischemia to more than 6 hours in certain patient populations to improve organ use.

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Graft Ischemic Time and Outcome of Lung Transplantation

Cited by 190 publications

References 21 publications

Cognitive Function, Mental Health, and Health-related Quality of Life after Lung Transplantation

Cognitive Function, Mental Health, and Health-related Quality of Life after Lung Transplantation

Prolonged Lung Allograft Ischemia and Posttransplant Outcome

Association Between Prolonged Graft Ischemia and Primary Graft Failure or Survival Following Lung Transplantation

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