A prospective trial of inhaled nitric oxide in clinical lung transplantation

Background. Reperfusion injury (RI) is a major cause of mortality and morbi dity among lung transplant recipients. We sought to determine if prophylact ic administration of inhaled nitric oxide (NO) to lung transplant recipient s at reperfusion would prevent RI. We also hypothesized that if prophylacti c NO proves ineffective in preventing RI then it may improve pulmonary hemo dynamics and gas exchange in the subset of patients who develop RI. Methods. After informed consent, 28 consecutive, adult lung transplant reci pients 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 NO was withdrawn for 15 min at 6 and 12 hr after reperfusion, and gas exchange and hemodynamics were meas ured. Results. Five of the 28 lung transplant recipients (18%) developed RI. With drawal of NO for 15 min in this subset of patients resulted in a significan t rise in mean pulmonary artery pressure and a reduction in oxygenation ind ex. 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 mort ality in this group was 20% (1/5), The remaining 23 patients without RI had uneventful early postoperative course and were weaned from NO and mechanic al ventilation within 36 hr of transplantation. Conclusions. Prophylactic-inhaled NO does not prevent RI in human lung tran splantation. However, inhaled NO, started at reperfusion, improves gas exch ange and reduces pulmonary artery pressure in those patients who develop RI .