*Purpose: Within the first 72 hours of lung transplant, recipients may develop primary graft dysfunction (PGD). This complication is associated with acute and chronic rejection, and PGD Grade 3 at 72 hours is a known predictor of early mortality. Supportive therapy is standard of care; however, inhaled vasodilators, such as inhaled nitric oxide (iNO), have been used for both prevention and treatment of PGD. Inhaled epoprostenol (iEPO) is another pulmonary vasodilator, which has not been well studied in lung transplant but demonstrates non inferiority to iNO in other indications and has a cost advantage. The objective of this study is to evaluate the impact of inhaled vasodilator therapy (either iNO or iEPO) on PGD in lung transplant recipients.

*Methods: This was a retrospective, single centered, cohort study of adult lung transplant recipients from January 2011 to December 2017. Patients were excluded if they were <18 years old, had inhaled vasodilator started more than 24 hours after arrival to the intensive care unit (ICU) or had multiple organs transplanted simultaneously. The primary endpoint was PGD at 72 hours after lung transplant in patients that received either inhaled vasodilator compared to those that did not. Secondary endpoints included PGD at 0, 24 and 48 hours, acute cellular rejection (ACR) within the first 6 months, ICU length of stay (LOS), hospital LOS, hemodynamic data, development of deep vein thrombosis (DVT) prior to discharge, and graft survival at 30 days and 6 months.

*Results: There were 18 patients in the iEPO group, 51 patients in the iNO group, and 45 patients who did not receive a vasodilator. The primary outcome of PGD at 72 hours was not different among the three groups (p=0.28). There was no difference in PGD at 0 (p=0.99), 24 (p=0.06) or 48 hours (p=0.28). ACR was detected in 19 (42.4%) patients in the no vasodilator group, 34 (70.8%) patients in the iNO group, and 5 (27.8%) patients in the iEPO group (p<0.01). Hospital and ICU LOS were significantly longer in the iNO and iEPO groups compared to no vasodilator (p<0.01). No patients in the iEPO group had DVT prior to discharge, compared to 21.7% in the iNO group and 6.8% in the no vasodilator group (p=0.02). Graft survival at 30 days and 6 months was significantly higher in the no vasodilator group compared to either vasodilator.

*Conclusions: The current study found no difference in PGD scores at 72 hours in lung transplant patients who received iNO, iEPO or no vasodilator therapy. Patients who received iEPO were less likely to have ACR and were also less likely to have a DVT prior to discharge. Larger, prospective studies are needed to evaluate effects of inhaled vasodilator for management and prevention of PGD as well as whether iEPO has a beneficial anti-inflammatory, anti-thrombotic effect in lung transplant recipients.

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