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J Thorac Cardiovasc Surg 1996;112:293-299
© 1996 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

CARDIAC AND PULMONARY REPLACEMENT
INHALED NITRIC OXIDE IMPROVES LUNG ALLOGRAFT FUNCTION AFTER PROLONGED STORAGE

Kan Okabayashi, MDa, Anastasios N. Triantafillou, MDb, Motohiro Yamashita, MDa, Motoi Aoe, MDa, Steve R. DeMeester, MDa, Joel D. Cooper, MD, FRCS(C)a, G. Alexander Patterson, MD, FRCS(C)a

Supported by National Institutes of Health grants 1 R01 HL41281 and R01 HL41943.

Presented in part at the Eightieth Annual Clinical Congress of American College of Surgeons (Surgical Forum), Chicago, Ill., Oct. 9-14, 1994.

Received for publication June 26, 1995 Accepted for publication Oct. 2, 1995. Address for reprints: G. Alexander Patterson, MD, FRCS(C), Division of Cardiothoracic Surgery, Washington University School of Medicine, One Barnes Hospital Plaza, 3108 Queeny Tower, St. Louis, MO 63110.

Abstract

Morbidity caused by early allograft dysfunction, manifested by a progressive increase in pulmonary vascular resistance and a decrease in oxygenation, remains a serious problem in lung transplantation. Inhalation of nitric oxide, an essential homeostatic molecule, has been shown to have beneficial effects on a variety of acute lung injuries. The purpose of the present study was to investigate the effect of inhaled nitric oxide on posttransplant function of canine left lung allografts. Fourteen dogs underwent left lung allotransplantation. Donors received systemic heparin and prostaglandin E1followed by pulmonary artery flush with modified Euro-Collins solution. Donor left lungs were stored for 18 hours at 1º C and subsequently implanted. Immediately after reperfusion, the contralateral right main pulmonary artery and bronchus were ligated. The chest was closed and recipients turned to the supine position for the 6-hour assessment period. Hemodynamic and arterial and venous blood gas analyses were made at 15-minute intervals at an inspired oxygen fraction of 1.0 and 5 cm of water positive end-expiratory pressure. Animals were killed at the end of the assessment. Allograft myeloperoxidase activity assays and wet/dry weight ratios were done. In group I (n = 5), nitric oxide gas was administered continuously at concentrations of 60 to 70 ppm before reperfusion and throughout the 6-hour assessment period. In group II (n = 5), nitric oxide administration was initiated at the same concentration after reperfusion injury had developed. Group III animals (n = 4) received no nitric oxide. Significant improvement in gas exchange was apparent in group I. At the end of the 6-hour assessment period, mean arterial oxygen <abs2>tension was 253.8 ± 44.7 mm Hg and 114.9 ± 25.5 mm Hg in groups I and III, respectively (p < 0.05). Group II animals had no improvement in oxygenation with nitric oxide. Systemic hemodynamics were unaffected by nitric oxide. However, an immediate decrease in pulmonary vascular resistance was noted. Group I myeloperoxidase activity was significantly lower than that in control group III (0.24 ± 0.06 versus 0.36 ± 0.04 units, respectively; p < 0.05). (J THORACCARDIOVASCSURG1996;112:293-9)




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