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Exhaled Nitric Oxide and Impaired Oxygenation in Cirrhotic Patients before and after Liver Transplantation

Giovanni Rolla, MD; Luisa Brussino, MD; Paola Colagrande, MD; Ermanno Scappaticci, MD; Mara Morello, MD; Serena Bergerone, MD; Antonio Ottobrelli, MD; Elisabetta Cerutti, MD; Salvatore Polizzi, MD; and Caterina Bucca, MD
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From University of Torino and Ospedale Molinette di Torino, Torino, Italy. For current author addresses, see end of text. Acknowledgments: The authors thank Dr. Silvana Cannizzo for technical support. Grant Support: By a grant from the Ministero Italiano dell'Universita e della Ricerca Scientifica. Requests for Reprints: Giovanni Rolla, MD, Dipartimento di Scienze Biomediche e Oncologia Umana, via Genova 3, 10126 Torino, Italy. Current Author Addresses: Drs. Rolla, Brussino, Colagrande, and Bucca: Dipartimento di Scienze Biomediche e Oncologia Umana, via Genova 3, 10126 Torino, Italy.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;129(5):375-378. doi:10.7326/0003-4819-129-5-199809010-00005
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Background: Nitric oxide may be involved in the impaired oxygenation of cirrhotic patients, a condition that improves in most patients after liver transplantation.

Objective: To compare oxygenation and nitric oxide concentrations before and after liver transplantation.

Design: Before-and-after observational study.

Setting: Academic medical center.

Patients: 18 patients with cirrhosis and no obvious cardiopulmonary disease who underwent successful orthotopic liver transplantation.

Intervention: Orthotopic liver transplantation.

Measurements: Blood gas analysis, measurement of exhaled nitric oxide, contrast-enhanced echocardiography, and pulmonary function tests.

Results: Before transplantation, the mean (±SD) exhaled nitric oxide concentration was higher in patients than in normal controls (13 ± 4.9 parts per billion [ppb] compared with 5.75 ± 1.9 ppb; P < 0.001). After transplantation, the alveolar-arterial oxygen gradient significantly decreased (from 17.3 ± 7.1 mm Hg to 9 ± 5.2 mm Hg; P < 0.001), as did the exhaled nitric oxide concentration (from 13 ± 4.9 ppb to 6.2 ± 2.8 ppb; P < 0.001). The decrease in the exhaled nitric oxide concentration was significantly correlated with the decrease in the alveolar-arterial oxygen gradient (r = 0.56; P = 0.014). Five patients met the criteria for the diagnosis of the hepatopulmonary syndrome before transplantation; the syndrome was cured by transplantation.

Conclusions: The correlation between the decrease in exhaled nitric oxide concentration after liver transplantation and the improvement in oxygenation reinforces the hypothesis that nitric oxide is an important mediator of impaired oxygenation in patients with cirrhosis.


Grahic Jump Location
Figure 1.
Correlation between the differences in alveolar-arterial oxygen gradient and exhaled nitric oxide concentrations before and after liver transplantation.

ppb = parts per billion.

Grahic Jump Location




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