A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation.
Decreases in endothelial nitric oxide synthase derived nitric oxide (NO) production during liver transplantation promotes injury. We hypothesized that preemptive inhaled NO (iNO) would improve allograft function (primary) and reduce complications post-transplantation (secondary). Patients at two uni...
Guardado en:
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | article |
Lenguaje: | EN |
Publicado: |
Public Library of Science (PLoS)
2014
|
Materias: | |
Acceso en línea: | https://doaj.org/article/a1804e87351e4177a82c6305bacd9369 |
Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
id |
oai:doaj.org-article:a1804e87351e4177a82c6305bacd9369 |
---|---|
record_format |
dspace |
spelling |
oai:doaj.org-article:a1804e87351e4177a82c6305bacd93692021-11-18T08:32:54ZA randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation.1932-620310.1371/journal.pone.0086053https://doaj.org/article/a1804e87351e4177a82c6305bacd93692014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24533048/?tool=EBIhttps://doaj.org/toc/1932-6203Decreases in endothelial nitric oxide synthase derived nitric oxide (NO) production during liver transplantation promotes injury. We hypothesized that preemptive inhaled NO (iNO) would improve allograft function (primary) and reduce complications post-transplantation (secondary). Patients at two university centers (Center A and B) were randomized to receive placebo (n = 20/center) or iNO (80 ppm, n = 20/center) during the operative phase of liver transplantation. Data were analyzed at set intervals for up to 9-months post-transplantation and compared between groups. Patient characteristics and outcomes were examined with the Mann-Whitney U test, Student t-test, logistic regression, repeated measures ANOVA, and Cox proportional hazards models. Combined and site stratified analyses were performed. MELD scores were significantly higher at Center B (22.5 vs. 19.5, p<0.0001), surgical times were greater at Center B (7.7 vs. 4.5 hrs, p<0.001) and warm ischemia times were greater at Center B (95.4 vs. 69.7 min, p<0.0001). No adverse metabolic or hematologic effects from iNO occurred. iNO enhanced allograft function indexed by liver function tests (Center B, p<0.05; and p<0.03 for ALT with center data combined) and reduced complications at 9-months (Center A and B, p = 0.0062, OR = 0.15, 95% CI (0.04, 0.59)). ICU (p = 0.47) and hospital length of stay (p = 0.49) were not decreased. iNO increased concentrations of nitrate (p<0.001), nitrite (p<0.001) and nitrosylhemoglobin (p<0.001), with nitrite being postulated as a protective mechanism. Mean costs of iNO were $1,020 per transplant. iNO was safe and improved allograft function at one center and trended toward improving allograft function at the other. ClinicalTrials.gov with registry number 00582010 and the following URL:http://clinicaltrials.gov/show/NCT00582010.John D LangAlvin B SmithAngela BrandonKelley M BradleyYuliang LiuWei LiD Ralph CroweNirag C JhalaRichard C CrossLuc FrenetteKenneth MartayYouri L VaterAlexander A VitinGregory A DemboDerek A DubayJ Steven BynonJeff M SzychowskiJorge D ReyesJeffrey B HalldorsonStephen C RayhillAndre A DickRamasamy BakthavatsalamJared BrandenbergerJo Ann Broeckel-ElrodLaura Sissons-RossTerry JordanLucinda Y ChenArunotai SiriussawakulDevin E EckhoffRakesh P PatelPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 2, p e86053 (2014) |
institution |
DOAJ |
collection |
DOAJ |
language |
EN |
topic |
Medicine R Science Q |
spellingShingle |
Medicine R Science Q John D Lang Alvin B Smith Angela Brandon Kelley M Bradley Yuliang Liu Wei Li D Ralph Crowe Nirag C Jhala Richard C Cross Luc Frenette Kenneth Martay Youri L Vater Alexander A Vitin Gregory A Dembo Derek A Dubay J Steven Bynon Jeff M Szychowski Jorge D Reyes Jeffrey B Halldorson Stephen C Rayhill Andre A Dick Ramasamy Bakthavatsalam Jared Brandenberger Jo Ann Broeckel-Elrod Laura Sissons-Ross Terry Jordan Lucinda Y Chen Arunotai Siriussawakul Devin E Eckhoff Rakesh P Patel A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
description |
Decreases in endothelial nitric oxide synthase derived nitric oxide (NO) production during liver transplantation promotes injury. We hypothesized that preemptive inhaled NO (iNO) would improve allograft function (primary) and reduce complications post-transplantation (secondary). Patients at two university centers (Center A and B) were randomized to receive placebo (n = 20/center) or iNO (80 ppm, n = 20/center) during the operative phase of liver transplantation. Data were analyzed at set intervals for up to 9-months post-transplantation and compared between groups. Patient characteristics and outcomes were examined with the Mann-Whitney U test, Student t-test, logistic regression, repeated measures ANOVA, and Cox proportional hazards models. Combined and site stratified analyses were performed. MELD scores were significantly higher at Center B (22.5 vs. 19.5, p<0.0001), surgical times were greater at Center B (7.7 vs. 4.5 hrs, p<0.001) and warm ischemia times were greater at Center B (95.4 vs. 69.7 min, p<0.0001). No adverse metabolic or hematologic effects from iNO occurred. iNO enhanced allograft function indexed by liver function tests (Center B, p<0.05; and p<0.03 for ALT with center data combined) and reduced complications at 9-months (Center A and B, p = 0.0062, OR = 0.15, 95% CI (0.04, 0.59)). ICU (p = 0.47) and hospital length of stay (p = 0.49) were not decreased. iNO increased concentrations of nitrate (p<0.001), nitrite (p<0.001) and nitrosylhemoglobin (p<0.001), with nitrite being postulated as a protective mechanism. Mean costs of iNO were $1,020 per transplant. iNO was safe and improved allograft function at one center and trended toward improving allograft function at the other. ClinicalTrials.gov with registry number 00582010 and the following URL:http://clinicaltrials.gov/show/NCT00582010. |
format |
article |
author |
John D Lang Alvin B Smith Angela Brandon Kelley M Bradley Yuliang Liu Wei Li D Ralph Crowe Nirag C Jhala Richard C Cross Luc Frenette Kenneth Martay Youri L Vater Alexander A Vitin Gregory A Dembo Derek A Dubay J Steven Bynon Jeff M Szychowski Jorge D Reyes Jeffrey B Halldorson Stephen C Rayhill Andre A Dick Ramasamy Bakthavatsalam Jared Brandenberger Jo Ann Broeckel-Elrod Laura Sissons-Ross Terry Jordan Lucinda Y Chen Arunotai Siriussawakul Devin E Eckhoff Rakesh P Patel |
author_facet |
John D Lang Alvin B Smith Angela Brandon Kelley M Bradley Yuliang Liu Wei Li D Ralph Crowe Nirag C Jhala Richard C Cross Luc Frenette Kenneth Martay Youri L Vater Alexander A Vitin Gregory A Dembo Derek A Dubay J Steven Bynon Jeff M Szychowski Jorge D Reyes Jeffrey B Halldorson Stephen C Rayhill Andre A Dick Ramasamy Bakthavatsalam Jared Brandenberger Jo Ann Broeckel-Elrod Laura Sissons-Ross Terry Jordan Lucinda Y Chen Arunotai Siriussawakul Devin E Eckhoff Rakesh P Patel |
author_sort |
John D Lang |
title |
A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
title_short |
A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
title_full |
A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
title_fullStr |
A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
title_full_unstemmed |
A randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
title_sort |
randomized clinical trial testing the anti-inflammatory effects of preemptive inhaled nitric oxide in human liver transplantation. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2014 |
url |
https://doaj.org/article/a1804e87351e4177a82c6305bacd9369 |
work_keys_str_mv |
AT johndlang arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT alvinbsmith arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT angelabrandon arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT kelleymbradley arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT yuliangliu arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT weili arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT dralphcrowe arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT niragcjhala arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT richardccross arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT lucfrenette arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT kennethmartay arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT yourilvater arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT alexanderavitin arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT gregoryadembo arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT derekadubay arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jstevenbynon arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jeffmszychowski arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jorgedreyes arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jeffreybhalldorson arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT stephencrayhill arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT andreadick arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT ramasamybakthavatsalam arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jaredbrandenberger arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT joannbroeckelelrod arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT laurasissonsross arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT terryjordan arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT lucindaychen arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT arunotaisiriussawakul arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT devineeckhoff arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT rakeshppatel arandomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT johndlang randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT alvinbsmith randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT angelabrandon randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT kelleymbradley randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT yuliangliu randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT weili randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT dralphcrowe randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT niragcjhala randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT richardccross randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT lucfrenette randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT kennethmartay randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT yourilvater randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT alexanderavitin randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT gregoryadembo randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT derekadubay randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jstevenbynon randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jeffmszychowski randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jorgedreyes randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jeffreybhalldorson randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT stephencrayhill randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT andreadick randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT ramasamybakthavatsalam randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT jaredbrandenberger randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT joannbroeckelelrod randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT laurasissonsross randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT terryjordan randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT lucindaychen randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT arunotaisiriussawakul randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT devineeckhoff randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation AT rakeshppatel randomizedclinicaltrialtestingtheantiinflammatoryeffectsofpreemptiveinhalednitricoxideinhumanlivertransplantation |
_version_ |
1718421638565855232 |