Serial monitoring of exhaled nitric oxide in lung transplant recipients

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:34

Article

Gashouta, Mohamed A.¹  Merlo, Christian A.²  Pipeling, Matthew R.³  McDyer, John F.³  Hayanga, J. W. Awori⁴  Orens, Jonathan B.²  Girgis, Reda E.⁴ 

[1] St Lukes Hosp, Dept Internal Med, Chesterfield, MO 63017 USA

[2] Johns Hopkins Univ, Sch Med, Div Pulm & Crit Care Med, Baltimore, MD USA

[3] Univ Pittsburgh, Div Pulm Allergy & Crit Care Med, Pittsburgh, PA USA

[4] Michigan State Univ, Spectrum Hlth, Richard DeVos Heart & Lung Transplant Program, Grand Rapids, MI USA

关键词: exhaled nitric oxide;    lung transplantations;    acute rejection;    infection;    bronchiolitis obliterans syndrome;   

DOI  :  10.1016/j.healun.2014.09.026

来源: Elsevier

【 摘 要 】

BACKGROUND: Exhaled nitric oxide (FeNO), a marker of airway inflammation, is often elevated in lung transplant recipients (LTxRs) with acute rejection or infection. Isolated measurements in the setting of bronchiolitis obliterans syndrome have been variable. We sought to assess the utility of serial FeNO in predicting chronic allograft dysfunction or the presence of acute rejection or infection. METHODS: Eighty-six LTxRs underwent 325 serial FeNO measurements at an expiratory flow rate of 50 ml/s. The change in FeNO (Delta FeNO) between two measurements obtained during a stable state (Delta FeNO-SS) was compared with Delta FeNO, where the first measurement was taken during a stable state and the second during an unstable state (defined as a subsequent decline in FEVI > 10% over 3 months [Delta FeNO-SU]) or an acute complication (acute rejection, lymphocytic bronchiolitis or acute infection [Delta FeNO-SAC]). The median follow-up time after the baseline FeNO was 10 (range 3 to 25) months. RESULTS: Delta FeNO-SS in 117 FeNO pairs was similar to Delta FeNO-SU in 26 pairs (2.1 +/- 3 ppb vs 2.3 +/- 4 ppb; p = 0.2). Delta FeNO-SAC in 17 pairs was markedly increased (27 +/- 20 ppb; p < 0.001 vs Delta FeNO-SS). The area under the receiver-operating characteristic curve for AFeN0 in detecting an acute complication was 0.93 (p < 0.001). By applying a cut-off of > 10 ppb, the sensitivity and specificity was 82% and 100%, respectively, with positive and negative predictive values of 100% and 97.5%. CONCLUSIONS: Changes in FeNO may serve as a useful adjunct in the detection of acute complications after lung transplantation. In this limited analysis, Delta FeNO was not predictive of a subsequent decline in allograft function. (C) 2015 International Society for Heart and Lung Transplantation. All rights reserved.

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