Exhaled nitric oxide and carbon monoxide in lung transplanted patients. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Cameli, P.; Bargagli, E.; Fossi, A.; Bennett, D.; Voltolini, L.; Refini, R.M.; Gotti, G.; Rottoli, P.
• Is Part Of: Respiratory medicine. Volume 109:Issue 9(2015)
• Page Start: 1224
• Page End: 1229
• Publication Date: 2015-09
• Subjects: Nitric oxide -- Lung transplantation -- Biomarker -- Bronchiolitis obliterans syndrome; LTX lung transplant -- SLTX single lung transplant -- SSLTX sequential single lung transplant -- NO nitric oxide -- eNO exhaled nitric oxide -- FeNO fractional exhaled nitric oxide -- CalvNO alveolar concentration of NO -- eCO exhaled carbon monoxide -- J'awNO maximum conducting airway wall flux -- IPF idiopathic pulmonary fibrosis -- BAL bronchoalveolar lavage -- CF cystic fibrosis -- PFT pulmonary function tests -- TLC total lung capacity -- FVC forced vital capacity -- TLCO transfer factor of the lung for carbon monoxide -- COPD chronic obstructive pulmonary disease; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2015.07.005
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Exhaled nitric oxide (eNO) and carbon monoxide (eCO) are markers of pulmonary inflammation associated with acute graft rejection and lung infections in lung transplant (LTX) recipients. Regarding eNO and eCO levels in LTX patients affected by bronchiolitis obliterans syndrome (BOS), published data are discordant. Objectives: We aim to evaluate eNO at multiple flows, alveolar concentration of nitric oxide (CalvNO ), maximum conducting airway wall flux (J'awNO ) and eCO levels in LTX patients to assess the potential role of these parameters in BOS evaluation. Methods: Fractional exhaled nitric oxide (FeNO), CalvNO and J'awNO were analysed in 30 healthy subjects and 27 stable LTX patients (12 BOS patients). Pulmonary function tests were performed after eNO and eCO assessment. Receiver operating characteristic (ROC) curves were conducted to evaluate diagnostic accuracy for BOS of eNO parameters. Results: LTX patients reported higher values of FeNO at flow rates of 50 (p < 0.01), 150 (p < 0.05), 350 ml/s (p < 0.001), and CalvNO (p < 0.0001) than healthy controls. BOS patients showed higher FeNO at flow rates of 150 (p < 0.05) and 350 ml/s (p < 0.01) and CalvNO (p < 0.001) than non-BOS patients. CalvNO reported a remarkable diagnostic accuracy for BOS (AUC: 0.82). There were no significant differences of eCO levels between LTX patients and healthy controls. Conclusion: LTX patients affected by BOS showed higher levels of FeNO 150 and 350, and CalvNO than non-BOS LTX patients, probably due to chronic airway inflammation and fibrotic remodelling. CalvNO may be a potential biomarker of BOS in LTX patients. Highlights: We measure exhaled NO levels in lung transplanted patients. Alveolar NO and peripheral NO was higher in patients affected by BOS. Alveolar concentration of NO is not correlated with BOS severity. Alveolar concentration of NO could be a potential biomarker of BOS.