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a Department of Respiratory Medicine, b Department of Cardiopulmonary Transplantation, c Freeman Hospital,
Newcastle upon Tyne NE7 7DN, UK
Correspondence to: Dr P A Corris.
Received 24 September 1997; Returned to authors 2 December 1997; Revised version received 30 January 1998; Accepted for publication 30 January 1998
BACKGROUND
The role of nitric oxide (NO) in the
pathophysiology of graft dysfunction following lung transplantation
remains unclear. To determine whether measurement of NO in the exhaled
breath of lung transplant recipients provides useful information about
graft pathology, a cross sectional study was performed on a cohort of recipients as they attended for review.
METHODSOne hundred and four lung transplant
recipients and 55 healthy non-smoking controls were included in the
study. Each subject performed three consecutive single breath NO
manoeuvres. In recipients NO levels were compared according to current
clinical status, presence of any graft pathology, type of lung
transplant procedure, indication for transplantation, and current level
of immunosuppression.
RESULTSMean (SE) exhaled NO levels were 6.5 (0.61) ppb in the control group, 5.3 (0.46) in clinically well
recipients, 10.3 (1.4) in those with lymphocytic bronchiolitis, 10.5 (1.0) in recipients with infection, and 2.5 (0.6) in those with acute
vascular rejection. There was no significant difference in NO levels
between the control group and lung transplant recipients as a whole
(mean difference 0.29 (95% CI -1.17 to 1.75), p = 0.7). Levels were
increased significantly in the presence of lymphocytic bronchiolitis
(4.98 (95% CI 1.6 to 8.36), p = 0.0002) and infection (5.28 (95% CI
2.9 to 7.56), p<0.0001), but not in acute vascular rejection (2.76 (95% CI 0.97 to 4.55), p = 0.1) compared with exhaled NO in clinically
well recipients. Recipients with obliterative bronchiolitis were
subdivided according to the grade of their bronchiolitis obliterans
syndrome (BOS). Exhaled NO levels in those with BOS grade 1 were 10.0 (1.3) ppb and in those with BOS grades 2 or 3 were 5.1 (0.7) ppb.
Compared with those who were clinically well, NO levels were increased in those with BOS grade 1 (4.74 (95% CI 1.8 to 7.69), p < 0.0001) but
not in those with BOS grades 2 or 3 (0.19 (95% CI -1.55 to 1.93), p = 0.82).
CONCLUSIONSExhaled NO levels are increased in
lung transplant recipients with lymphocytic bronchiolitis, early
obliterative bronchiolitis, and infection. These conditions are all
associated with the presence of airway inflammation within the graft.
The findings suggest that exhaled NO measurements may have a role as a
marker of pulmonary allograft dysfunction.
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