Inhaled nitric oxide therapy and renal dysfunction in lung transplant patients with allograft dysfunction

Purpose: Early lung allograft dysfunction (AD) is the most frequent cause of morbidity and mortality following lung transplantation. Since February 1993, we have effectively utilized inhaled nitric oxide (INO) to treat AD. Recent information suggests that prolonged use of INO may result in renal dysfunction (RD). The purpose of this review is to examine our own experience with INO in patients with AD and to evaluate its association with RD Methods: Our center performed 215 adult lung transplants between February 1993 and July 1997. A retrospective chart analysis of 29 patients with severe AD, who received INO for ≥24 hours, was completed. There were 14 females and 15 males with a mean age of 48 years (range:30-62). Transplant indications included: emphysema (11), pulmonary fibrosis (7), primary pulmonary hypertension (6), bronchiectasis (4), and bronchiolitis obliterans (1). All patients received standard 3 drug immunosuppression (cyclosporine (CSA), azathioprine, and steroids). Results: In 18 patients, recovery of AD was prompt with a median INO treatment period of 2 days. Serum creatinine levels remained normal. Five patients, with an otherwise uncomplicated recovery and a modest elevation of creatine (1.41-2.09), had a median INO treatment period of 7 days. In 6 patients with a median INO regimen of 10 days, creatine levels were markedly increased (5:2.8). Inotropic support was utilized in all 6 patients. Three of the 6 patients were placed on ECMO. RD was attributed to acute tubular necrosis caused by hypovolemia, inotropics, ECMO support, elevated CSA levels, or sepsis. Five of these 6 patients had early postop mortality; DIC(2), MOF(1), massive hemoptysis(1), and hemorrhage(1). Conclusions: In the absence of co-morbidity, lung transplant recipients receiving INO for AD are not at risk for renal failure. Clinical Implications: INO is an effective therapy for AD and not in itself a risk factor for RD.