J.D. Lang, Jr, M.D.
The purpose of this prospective study is to further document the efficacy and safety of inhaled nitric oxide (NO) in decreasing damage to the liver during liver transplantation. Hepatic ischemia-reperfusion (no blood flow and then reestablishing blood) leads to significant systemic inflammatory response (an infection-like response). This response involves numerous complex reactions that ultimately contribute to liver injury. The consequences of these actions may lead to acute graft dysfunction (the new donor liver to malfunction at the time of or shortly after surgery)/ failure or transient graft dysfunction (temporary malfunction of the new donor liver), but may also be responsible for other organs to fail, such as lung and kidney. Recent studies in children and adults document the effectiveness with inhaled NO. Inhaled NO has shown effectiveness in improving a number of clinical syndromes associated with high pressures in the lungs such as: (1) adult respiratory syndrome, (2) chronic obstructive pulmonary disease, (3) mitral valve disease, (4) cardiac and lung transplantation, (5) persistent pulmonary hypertension of the newborn, and (6) congenital heart disease. Surprisingly, the potential anti-inflammatory (decreased inflammation) properties of administering NO before the liver is transplanted has remained unexplored clinically, while a considerable number of well-designed liver surgery animal studies have demonstrated benefit.