A prospective trial of inhaled nitric oxide in clinical lung transplantation.
BACKGROUND
Reperfusion injury (RI) is a major cause of mortality and morbidity among lung transplant recipients. We sought to determine if prophylactic administration of inhaled nitric oxide (NO) to lung transplant recipients at reperfusion would prevent RI. We also hypothesized that if prophylactic NO proves ineffective in preventing RI then it may improve pulmonary hemodynamics and gas exchange in the subset of patients who develop RI.


METHODS
After informed consent, 28 consecutive, adult lung transplant recipients received NO at 20 ppm at reperfusion. NO was withdrawn for 15 min at 6 and 12 hr after reperfusion, and gas exchange and hemodynamics were measured.


RESULTS
Five of the 28 lung transplant recipients (18%) developed RI. Withdrawal of NO for 15 min in this subset of patients resulted in a significant rise in mean pulmonary artery pressure and a reduction in oxygenation index. All five patients with RI were kept on inhaled NO until full functional recovery of the allograft and were then weaned from mechanical ventilation. None required extracorporeal membrane oxygenation support; the early mortality in this group was 20% (1/5). The remaining 23 patients without RI had uneventful early postoperative course and were weaned from NO and mechanical ventilation within 36 hr of transplantation.


CONCLUSIONS
Prophylactic-inhaled NO does not prevent RI in human lung transplantation. However, inhaled NO, started at reperfusion, improves gas exchange and reduces pulmonary artery pressure in those patients who develop RI.
Ardehali
A
A
Division of Cardiothoracic Surgery, Department of Surgery, UCLA Medical Center, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA. aardehali@mednet.ucla.edu.
Laks
H
H
Levine
M
M
Shpiner
R
R
Ross
D
D
Watson
L D
LD
Shvartz
O
O
Sangwan
S
S
Waters
P F
PF
D000280:Administration, Inhalation; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D008102:Liver Circulation / Q000187:drug effects*; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control*; D012121:Respiration, Artificial; D014184:Transplantation, Homologous; D017211:Treatment Failure
D009569:Nitric Oxide