INTRODUCTION AND OBJECTIVES:Primary graft dysfunction (PGD) following lung transplantation (LT) is associated with an activation of the inflammatory cascade and release of cytokines. Inhaled nitric oxide (iNO) provides specific pulmonary vasodilatation and improves oxygenation. Our objective was to verify whether administering iNO to LT patients modified the blood and bronchoalveolar lavage (BAL) interleukin (IL)-6 and -8 levels in the event of PGD. MATERIALS AND METHODS:Thirty-two LT patients were randomized to the iNO treatment or the control group. Patients in the first group were given 10 ppm of iNO from the start of LT until 48 hours afterward. BAL and peripheral arterial blood samples were taken preimplantation as well as 12, 24, as and 48 hours postreperfusion. RESULTS: The iNO treatment group showed a lower incidence of PGD (29%) in comparison with the control group (40%). Significant differences (P < .05) were observed in the iNO group, with lower IL-6 levels at 12 hours in blood and BAL. A lower percentage of IL-8 was also detected in the iNO group at 24 hours in BAL and at 12 hours in blood and BAL. CONCLUSIONS: Lung transplant recipients develop an inflammatory response following implantation with systemic elevation of IL-6 and significant local elevation of IL-8 within the first few hours, especially in the event of PGD. In our series, iNO appeared to modulate the inflammatory response by reducing IL concentrations found immediately after reimplantation, and this reduction was related to a lower incidence of PGD.
RCT Entities:
INTRODUCTION AND OBJECTIVES:Primary graft dysfunction (PGD) following lung transplantation (LT) is associated with an activation of the inflammatory cascade and release of cytokines. Inhaled nitric oxide (iNO) provides specific pulmonary vasodilatation and improves oxygenation. Our objective was to verify whether administering iNO to LT patients modified the blood and bronchoalveolar lavage (BAL) interleukin (IL)-6 and -8 levels in the event of PGD. MATERIALS AND METHODS: Thirty-two LT patients were randomized to the iNO treatment or the control group. Patients in the first group were given 10 ppm of iNO from the start of LT until 48 hours afterward. BAL and peripheral arterial blood samples were taken preimplantation as well as 12, 24, as and 48 hours postreperfusion. RESULTS: The iNO treatment group showed a lower incidence of PGD (29%) in comparison with the control group (40%). Significant differences (P < .05) were observed in the iNO group, with lower IL-6 levels at 12 hours in blood and BAL. A lower percentage of IL-8 was also detected in the iNO group at 24 hours in BAL and at 12 hours in blood and BAL. CONCLUSIONS: Lung transplant recipients develop an inflammatory response following implantation with systemic elevation of IL-6 and significant local elevation of IL-8 within the first few hours, especially in the event of PGD. In our series, iNO appeared to modulate the inflammatory response by reducing IL concentrations found immediately after reimplantation, and this reduction was related to a lower incidence of PGD.
Authors: Stefano Gianni; Caio C A Morais; Grant Larson; Riccardo Pinciroli; Ryan Carroll; Binglan Yu; Warren M Zapol; Lorenzo Berra Journal: Nitric Oxide Date: 2020-08-21 Impact factor: 4.427