The study by Thabut and colleagues describes a greater incidence of PGF compared with earlier reports,1–3 and this is likely due to the inclusion of patients with less severe hypoxemia. Yet, the ICU mortality rate in the PGF group was similar to those in findings from other centers.1,3 In addition, the present report found prolonged ischemia time to be a significant influence on the outcome of patients experiencing PGF. In contrast, another group reported7 that prolonged graft ischemia time (ie, > 6 h) did not increase the risk of graft dysfunction. Others have reported,6 that graft ischemia time alone does not increase the risk of early mortality; however, an interaction between ischemia time and donor age increases this prospect. Other reports3 also have indicated that the type of preservation solution used, the recipient diagnosis, the year of transplantation, and the use of cardiopulmonary bypass are not significant risk factors. It would appear that factors other than graft ischemia time are concerned with the development of ischemia-reperfusion injury. Interestingly, a recent report12 examined the relationship between cytokine levels and graft ischemia time. These investigators reported that increased levels of interleukin-8, a proinflammatory cytokine and neutrophil chemotactic factor, correlated with the severity of oxygen impairment. In addition, older donors had diminished levels of interleukin-10, an anti-inflammatory cytokine, and this finding possibly may explain why older donors are more susceptible to ischemia-reperfusion injury and the associated increased mortality rate. However, cytokine levels were not influenced by ischemia time.