Inhaled iloprost in lung transplantation : Can it avoid extracorporeal circulation in patients with severe pulmonary hypertension?

i i c m o q c m p t t d t UNG TRANSPLANTATION (LTx) is performed for a variety of end-stage lung diseases and the outcome has mproved over the past decade.1 Even though most centers try o avoid the use of extracorporeal circulation (ECC) for LTx, ome centers prefer ECC in the majority of their transplants. he authors increasingly perform LTx without use of ECC if easible to avoid the known complications associated with CC, such as leukocyte and thrombocyte activation, release of asoactive substances, and damage of the capillary membrane n the early phase after reperfusion.2 The most common indiations for using ECC during LTx are deterioration of gas xchange during single-lung ventilation and consequent develpment of pulmonary hypertension with right-heart failure. Intravenous vasodilators have been used to avoid excessive ulmonary hypertension in LTx; however, this approach is limited ecause of the induction of systemic hypotension. As a conseuence, myocardial perfusion declines, which may lead to signifcant ischemia and ventricular decompensation. In addition, inrapulmonary shunting because of intravenous vasodilators may ead to impaired gas exchange. At this institution, the standard LTx protocol includes the inraoperative application of inhaled nitric oxide (iNO) before pneuonectomy to lower pulmonary vascular resistance (PVR), espeially in patients with pulmonary hypertension,3 and to avoid ight-heart failure during clamping of the pulmonary artery. A case f severe pulmonary hypertension associated with alpa-1-antitrypin-deficiency–related emphysema is reported in which inhaled loprost was used as a single therapeutic agent to avoid ECC upport during LTx.