Exhaled nitric oxide in human lung transplantation: A noninvasive marker of acute rejection

• Published in: American journal of respiratory and critical care medicine Vol. 157; no. 6; pp. 1822 - 1828
• Main Authors: SILKOFF, P. E, CARAMORI, M, TREMBLAY, L, MCCLEAN, P, CHAPARRO, C, KESTEN, S, HUTCHEON, M, SLUTSKY, A. S, ZAMEL, N, KESHAVJEE, S
• Format: Journal Article
• Language: English
• Published: New York, NY American Lung Association 01.06.1998
• Subjects: Adult; Biological and medical sciences; Biomarkers - analysis; Breath Tests; Bronchiolitis Obliterans - metabolism; Bronchoscopy; Female; Graft Rejection - diagnosis; Graft Rejection - metabolism; Humans; Lung Transplantation; Male; Medical sciences; Middle Aged; Nitric Oxide - analysis; Nitric Oxide - metabolism; Respiratory Tract Infections - metabolism; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Human; Lung disease; Graft(material); Respiratory disease; Acute; Lung; Biological marker; Transplantation; Differential diagnostic; Expired gas; Infection; Rejection; Surgery; Nitric oxide; Bronchus disease; Adult; Complication; Bronchiolitis obliterans
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.157.6.9707159

Acute allograft rejection in animals and humans has been associated with increased nitric oxide production in the graft. Exhaled nitric oxide (ENO) measurement is a noninvasive method of assessing inflammation in airway diseases, e.g., asthma, which might be applicable to lung transplant recipients. Over 12 months, ENO of lower respiratory origin was measured in 108 lung transplant recipients with a mean time after transplant of 1,083 d. ENO (mean +/- SEM; ppb) in stable patients (19.5 +/- 1.1; p < 0.001) was not different from that of healthy controls (23.8 +/- 3.2). ENO was significantly higher in episodes of clinical acute rejection (51.1 +/- 6.3) compared with stable patients but not elevated in bronchiolitis obliterans syndrome (18.6 +/- 1.5) or pulmonary infection (25.9 +/- 4.0). A retrospective analysis of bronchoscopy findings and concurrent ENO (n = 99) showed that ENO did not vary according to histological findings (normal, acute rejection grade I, nonspecific inflammatory change) or with a positive BAL culture. ENO was not correlated with differential lymphocyte and neutrophil counts. ENO appears to be a valid marker of clinical acute rejection in human lung transplantation as distinct from infection or bronchiolitis obliterans. Furthermore, bronchoscopic findings in the absence of a clinical illness were not associated with a rise in ENO.