Inhaled NO and prostacyclin during porcine single lung transplantation.
BACKGROUND
Increased pulmonary vascular resistance (PVR) and decreased arterial oxygenation frequently complicate lung transplantation. Inhaled nitric oxide (NO) and aerosolized prostacyclin (PGI2) both dilate the pulmonary vasculature and improve oxygenation in adult respiratory distress syndrome. We investigated whether similar effects would occur during early reperfusion of a lung graft.


METHODS
Eighteen pigs underwent left lung transplantation. We measured blood flow distribution, mean pulmonary artery pressure, PVR, and gas exchange in each lung separately. Animals were randomized into three groups to receive NO (10 ppm/30 minutes, 40 ppm/30 minutes), nebulized PGI2 (25 microg/mL/30 minutes, 50 microg/mL/30 minutes), or no drugs (control).


RESULTS
In the transplanted lung, PVR was significantly higher than in the native lung. Pulmonary vascular resistance of the transplanted lung was lower in the NO and PGI2 groups in comparison with the control group. During the first hour of inhalation, NO decreased PVR more than PGI2. Neither drug improved oxygenation in the graft.


CONCLUSIONS
Nitric oxide and PGI2 decreased PVR of the transplanted lung slightly, but the effect did not produce a normal pressure in pulmonary vasculature.
Vainikka
T L
TL
Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Finland. tiina.vainikka@hus.fi
Heikkilä
L J
LJ
Kukkonen
S
S
Toivonen
H J
HJ
D000280:Administration, Inhalation; D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D011464:Epoprostenol / Q000494:pharmacology*; D008168:Lung / Q000098:blood supply*; D016040:Lung Transplantation / Q000502:physiology*; D009569:Nitric Oxide / Q000494:pharmacology*; D010100:Oxygen / Q000097:blood; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D013552:Swine; D014664:Vasodilation / Q000187:drug effects*
D002245:Carbon Dioxide; D009569:Nitric Oxide; D011464:Epoprostenol; D010100:Oxygen