New Findings On Lung Transplantation And Esophageal Cancer

January 26, 1999

PITTSBURGH, Jan. 26 -- A number of papers are being presented by University of Pittsburgh Medical Center (UPMC) researchers at the Society of Thoracic Surgeons Thirty-Fifth Annual Meeting Monday, Jan. 25, through Wednesday, Jan. 27, in San Antonio. Following are highlights of clinical findings that will be presented:

Patient Survival Unchanged When Transplanting Lungs Preserved Beyond Six Hours

Current organ allocation policy is centered around the notion that lungs cannot safely be preserved beyond four to six hours, but a review of more than 350 cases at the University of Pittsburgh suggests that survival for patients who receive lungs preserved for more than six hours is no different than for patients who receive lungs preserved less than four hours.

James S. Gammie, M.D., a fellow in the division of cardiothoracic surgery, will present the results of the study that involved 352 lung transplants at the UPMC over the last 10 years during Tuesday's scientific sessions.

The cases were grouped according to ischemic time, the amount of time a donated organ is without blood supply. The time generally is calculated as the time from when an organ is removed from a donor until it is transplanted into a patient. Three ischemic times were examined in the study: less than four hours (91 patients), four to six hours (201 patients) and more than six hours (60 patients). The longest ischemic time was nearly nine hours. In each of the cases, the organs had been preserved using the same kind of solution and stored on ice until transplanted.

The UPMC surgeons then looked at patient survival, the incidence of acute and chronic rejection and other medical complications seen in lung transplant patients.

Actuarial survival was not significantly different among the three groups. In fact, the survival of recipients who received lungs stored longer than six hours was 68 percent at three years compared to 56 percent and 58 percent survival rates for lungs stored for less than four hours and between four to six hours, respectively. In addition, the incidence of rejection and organ function parameters were similar.

"The recipient who received lungs with an ischemic time of 8:58 is doing well more than six years after transplantation," reports Dr. Gammie.

"This data strongly suggest that, at the UPMC, transplanting lungs with longer ischemic times can yield positive outcomes. It is in our patients' best interest that we consider broadening the criteria by which we judge donors and determine policy," says Robert J. Keenan, M.D., associate professor of surgery in the division of cardiothoracic surgery, and senior author.

According to the United Network for Organ Sharing, there are more than 3,000 patients awaiting lung transplants. In 1997, 409 patients died waiting and 911 patients received transplants. Lungs are allocated to patients based on the amount of time accrued on the waiting list and according to their distance from the donor organ.
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