Current status of inhaled nitric oxide therapy for lung transplantation in Japan: a nationwide survey

Nobuyuki Yoshiyasu, Masaaki Sato, Daisuke Nakajima, Yasuaki Tomioka, Yui Watanabe, Takeshi Shiraishi, Soichiro Funaki, Sumiko Maeda, Koichi Tomoshige, Takahiro Nakajima, Tomoshi Tsuchiya, Seiichiro Sugimoto, Ichiro Yoshino, Takeshi Nagayasu, Masayuki Chida, Masato Minami, Yoshinori Okada, Shinichi Toyooka, Hiroshi Date, Jun Nakajima

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Objectives: Currently, inhaled nitric oxide (NO) therapy for lung transplantation is not covered by public health insurance in Japan. In this study, we evaluated the perioperative use and safety of inhaled NO therapy for lung transplantation. Methods: Data regarding the duration of treatment and adverse events of inhaled NO therapy were collected for all lung transplantations performed from January 1, 2015, to December 31, 2019, at nine lung transplant facilities in Japan. Results: During the study period, lung transplants were performed in 357 patients, among whom inhaled NO therapy was administered to 349 patients (98%). The median initial and median maximum inhaled NO doses were 10 and 20 ppm, respectively. Inhaled NO therapy was introduced during surgery and continued postoperatively in 313 patients (90%) for a median of 4 days. Significant improvements in oxygenation and decreases in pulmonary arterial pressure were observed in patients receiving inhaled NO therapy. Side effects of inhaled NO therapy, such as methemoglobinemia, were observed in 15 patients (4%), with a significant incidence in patients aged < 18 years. Conclusions: Inhaled NO therapy was performed in almost all patients who underwent lung transplantation in Japan and showed reasonable efficacy. Therefore, public health insurance coverage for inhaled NO therapy during lung transplantation is recommended.

Original languageEnglish
Pages (from-to)1421-1431
Number of pages11
JournalGeneral Thoracic and Cardiovascular Surgery
Issue number10
Publication statusPublished - 2021 Oct


  • Extracorporeal membrane oxygenation
  • Health insurance
  • Lung transplantation
  • Nitric oxide
  • Side effect


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