Inhaling Nitric Oxide Helps Liver Transplant Success

Administering inhaled nitric oxide (iNO) during surgery helps protect liver transplant patients from organ failure, according to a new study.

Researchers at the University of Alabama at Birmingham (UAB, USA) conducted a prospective, blinded, placebo-controlled study to patients undergoing liver transplantation. Patients were randomized to receive either placebo or iNO (80 ppm) during the operative period.

The study results (adjusted for cold ischemia time and sex) showed that iNO improved the rate at which liver function was restored after transplantation, significantly decreased hospital length of stay, and improved blood-clotting and liver-enzyme activity in post-transplant tests. iNO did not significantly affect changes in inflammatory markers in liver tissue one hour after reperfusion but significantly lowered hepatocyte apoptosis. Evaluation of circulating NO metabolites indicated that the most likely candidate transducer of the extrapulmonary effects of iNO was nitrite. The study was published in the September 2007 issue of the Journal of Clinical Investigation.

"We were pleasantly surprised at how good the inhaled NO patients performed after the results were gathered,” said co-author Rakesh Patel, Ph.D., an associate professor in the UAB Department of Pathology. But, he added, "exactly how the inhaled NO improves organ function at the cellular and molecular level is still unknown.”

Ischemia/reperfusion (IR) injury in transplanted livers, an unwanted side effect of restoring blood flow swiftly to a donor organ moments after transplantation, contributes to organ dysfunction and failure and is characterized in part by loss of NO bioavailability.


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