Exhaled nitric oxide correlates with experimental lung transplant rejection.

BACKGROUND: Increased nitric oxide production accompanies acute lung allograft rejection. Transforming growth factor-beta1 is an immunosuppressive cytokine capable of ameliorating acute rejection. The purpose of this study was to determine whether exhaled nitric oxide (eNO) concentrations correlated with the degree of acute rejection. METHODS: A model of acute lung transplant rejection in the rat was developed, and concentrations of eNO were measured at the time of animal sacrifice. In group 1 (partial immunosuppression), donor lungs were pretreated with transforming growth factor-beta1 before implantation. In group 2 (fulminant acute rejection), no immunosuppression was used. In group 3 (full immunosuppression), recipients received cyclosporine. Group 4 were normal rats. RESULTS: When measured from both lungs, eNO concentrations were 4.97+/-0.68 versus 6.73+/-2.90 ppb for groups 1 and 2, respectively (p = 0.58). When measured selectively from transplanted left lungs, eNO concentrations were 8.61+/-0.97 versus 42.14+/-7.27 ppb, respectively (p<0.001). In groups 3 and 4, eNO concentrations were 1.02+/-0.21 and 1.51+/-0.74 ppb, respectively. CONCLUSIONS: Exhaled nitric oxide is elevated in fulminant acute rejection, is reduced after partial immunosuppression using transforming growth factor-beta1 gene therapy, and is in the normal range in cyclosporine-treated animals. The measurement of eNO correlates with the degree of acute lung allograft rejection and may serve as a noninvasive measure of acute lung transplant rejection in the clinical setting.