Inhaled nitric oxide in the treatment of postoperative graft dysfunction after lung transplantation

Ian Adatia, Craig Lillehei, John H. Arnold, John E. Thompson, Regina Palazzo, James C. Fackler, David L. Wessel

Research output: Contribution to journalArticlepeer-review


Pulmonary hypertension and transient graft dysfunction may complicate the postoperative course of patients undergoing lung transplantation. We report the acute effect of inhaled nitric oxide (80 ppm) on hemodynamics and gas exchange in 6 patients (median age, 14 years; range, 5 to 21 years) after lung transplantation as well as the effect of extended treatment over 40 to 69 hours in 2 patients. In 5 patients with pulmonary hypertension nitric oxide lowered mean pulmonary artery pressure (from 38.4 ± 1.6 to 29.4 ± 3.1 mm Hg; p < 0.05), pulmonary vascular resistance index (from 9.3 ± 1.4 to 6.4 ± 1.3 Um2; p < 0.05), and intrapulmonary shunt fraction (from 28.6% ± 8.3% to 21.0% ± 5.7%; p < 0.05). There was a 28.4% ± 7.2% reduction in transpulmonary pressure gradient with only minor accompanying effects on the systemic circulation. Mean arterial pressure decreased only 2.7% ± 5% (from 76.4 ± 2.2 to 74 ± 2.3 mm Hg; p = not significant), and systemic vascular resistance index by 4.2% ± 9.7% (from 21.7 ± 3.1 to 20.6 ± 3.6 Um2; p = not significant). Cardiac index was unchanged (from 3.5 ± 0.8 to 3.6 ± 0.7 L · min-1 · m-2; p = not significant). Nitric oxide caused a sustained improvement in oxygenation and pulmonary artery pressure during extended therapy at doses of 10 ppm. There were no major side effects. However, transient methemoglobinemia (9%) developed in 1 patient after 10 hours of nitric oxide treatment. Nitric oxide may be useful in the treatment of pulmonary hypertension and the impaired gas exchange that occurs after lung transplantation.

Original languageEnglish (US)
Pages (from-to)1311-1318
Number of pages8
JournalThe Annals of thoracic surgery
Issue number5
StatePublished - May 1994
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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