Inhaled nitric oxide (NO) for the treatment of early allograft failure after lung transplantation

Byline: G. I. Kemming (1), M. J. Merkel (1), A. Schallerer (1), O. P. Habler (1), M. S. Kleen (1), M. Haller (1), J. Briegel (1), C. Vogelmeier (3), H. Furst (4), B. Reichart (5), B. Zwissler (1) Keywords: Key words Lung transplantation; Inhaled vasodilators; Nitric oxide; Pulmonary hypertension; Selective pulmonary vasodilation; Reperfusion injury Abstract: Objective: Inhalation of high concentrations of nitric oxide (NO) has been shown to improve gas exchange and to reduce pulmonary vascular resistance in individuals with ischemia-reperfusion injury following orthotopic lung transplantation. We assessed the cardiopulmonary effects of low doses of NO in early allograft dysfunction following lung transplantion. Design: Prospective clinical dose- response study. Setting: Anesthesiological intensive care unit of a university hospital. Patients and participants: 8 patients following a single or double lung transplantation who had a mean pulmonary arterial pressure (PAP) in excess of 4.7 kPa (35 mmHg) or an arterial oxygen tension/fractional inspired oxygen ratio (PaO.sub.2/FIO.sub.2) of less than 13.3 kPa (100 mmHg). Interventions: Gaseous NO was inhaled in increasing concentrations (1, 4 and 8 parts per million, each for 15 min) via a Siemens Servo 300 ventilator. Measurements and results: Cardiorespiratory parameters were assessed at baseline, after each concentration of NO, and 15 min after withdrawal of the agent [statistics: median (25th/75th percentiles: Q1/Q3), rANOVA, Dunnett's test, p &lt 0.05]. Inhaled NO resulted in a significant, reversible, dose-dependent, selective reduction in PAP from 5.5(5.2/6.0) kPa at control to 5.1(4.7/5.6) kPa at 1 ppm, 4.9(4.3/5.3) kPa at 4 ppm, and to 4.7(4.1/5.1) kPa at 8 ppm. PaO.sub.2 increased from 12.7(10.4/17.1) to 19.2(12.4/26.0) kPa at 1 ppm NO, to 23.9(4.67/26.7) kPa at 4 ppm NO and to 24.5(11.9/28.7) kPa at 8 ppm NO. All patients responded to NO inhalation (either with PAP or PaO.sub.2), all were subject to long-term inhalation (1--19 days). All were successfully weaned from NO and were discharged from the intensive care unit. Conclusion: The present study demonstrates that low-dose inhaled NO may be an effective drug for symptomatic treatment of hypoxemia and/or pulmonary hypertension due to allograft dysfunction subsequent to lung transplantation. Author Affiliation: (1) Department of Anesthesiology, Ludwig-Maximilians-Universitat Munchen, Klinikum Grosshadern, Marchioninistrasse 15, D-81 377 Munchen, Germany e-mail: bernhard.zwissler@ana.med.uni-muenchen.de Tel. + 49 (89) 7095-3417 Fax + 49 (89) 7095--8886, DE (2) Department of Surgical Research, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (3) Department of Internal Medicine, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (4) Department of Surgery, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE (5) Department of Cardiac Surgery, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany, DE Article note: Received: 23 February 1998 Accepted: 20 August 1998