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DRUG INFORMATION ROUNDS

Role of Inhaled Nitric Oxide in Adult Heart or Lung Transplant Recipients

Critical Care Specialist, Medical Intensive Care Unit, University of Pittsburgh Medical Center; Assistant Professor of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

Nicole T Ansani, PharmD

at time of writing, Associate Director of Drug Information, University of Pittsburgh Medical Center, and Assistant Professor of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh; now, Clinical Education Consultant, Pfizer, Inc., and Adjunct Assistant Professor, School of Pharmacy, University of Pittsburgh

Amy L Seybert, PharmD

Cardiology Specialist, Coronary Care Intensive Care Unit, University of Pittsburgh Medical Center; Pharmaceutical Care Coordinator, Critical Care Pharmacy; Assistant Professor of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh

Reprints: Dr. Rea, University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, 200 Lothrop St., 302 Scaife Hall, Pittsburgh, PA 15213-2582, fax 412/647-5847, rears{at}upmc.edu

OBJECTIVE: To evaluate the role of inhaled nitric oxide (iNO) in adult heart or lung transplant recipients.

DATA SOURCES: Pertinent literature was identified via a MEDLINE search (1966–July 2004).

DATA SYNTHESIS: Pulmonary hypertension leading to right ventricular failure and ischemic reperfusion injury are complications following heart or lung transplant, respectively. A study of 16 heart transplant patients showed improvement in hemodynamic parameters and preservation of right ventricular function, but no improvement in mortality using iNO. Studies of lung transplant patients showed no benefit of iNO on mechanical ventilation duration, hospital length of stay, or mortality, but some studies indicate an improvement in hemodynamic parameters.

CONCLUSIONS: iNO shows hemodynamic benefits in early postoperative heart transplant patients with preexisting pulmonary hypertension, and variable hemodynamic benefits in lung transplant recipients. Currently, morbidity and mortality data are not favorable for either indication; use of iNO is supportive and requires further study.

Key Words: nitric oxide, transplantation

Published Online, March 15, 2005. www.theannals.com, DOI 10.1345/aph.1E228