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Right-sided diaphragmatic hernia in infants after liver transplantation
Amanda J McCabe1, John D Orr, Khalid Sharif
1Department of Paediatric Surgery, Royal Hospital for Sick Children, EH9 1LF Edinburgh, UK.
Insights
Liver transplantation in infants is challenging due to recipient factors. This report details two cases of diaphragmatic hernia post-liver transplant, a previously unreported complication.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Liver transplantation in infants presents unique challenges compared to older children.
- Infants undergoing liver transplantation often have low body weight and severe end-stage liver disease.
- Diaphragmatic complications are more frequent in younger pediatric liver transplant recipients.
Observation:
- Diaphragmatic hernia has not been previously documented as a complication following liver transplantation.
- This report presents two pediatric patients who developed diaphragmatic hernia after liver transplantation.
- Several potential contributing factors were identified in these cases.
Findings:
- Factors contributing to diaphragmatic hernia include diaphragm thinness (due to low weight/malnutrition), surgical trauma, increased abdominal pressure from oversized grafts, and graft positioning.
- The combination of recipient factors and surgical considerations may predispose infants to diaphragmatic hernia post-transplant.
- This highlights a novel complication in pediatric liver transplantation.
Implications:
- Awareness of diaphragmatic hernia as a potential complication is crucial for pediatric liver transplant teams.
- Further investigation into the specific mechanisms and risk factors is warranted.
- This finding may influence surgical techniques and post-operative management in infant liver transplantation.
Abstract:
Liver transplantation is just as successful in infants as in older children, but more challenging. This relates to the low weight of the recipients and to their rapidly deteriorating clinical condition (malnutrition and end-stage liver disease) ( J Pediatr 1990;117:205-210; BMJ 1993;307:825-828; Ann Surg 1996;223:658-664; Transplantation 1997;64:242-248; J Pediatr Surg 1998;33:20-23). In addition, higher rates of diaphragmatic complications have been shown to significantly correlate with a younger age ( Transplantation 2002;73:228-232; Transpl Int 1998;11:281-283; Pediatr Transplant 2000;4:39-44), but diaphragmatic hernia has never been reported as a complication of liver transplantation. In this report, 2 patients who developed diaphragmatic hernia after liver transplantation are presented. The possible role of several contributing factors resulting in diaphragmatic hernia is discussed. These factors include (1) diaphragm thinness related to low weight and malnutrition, (2) direct trauma at operation (dissection and diathermy), (3) increased abdominal pressure after transplantation caused by the use of a slightly oversized liver graft, and (4) the medial positioning of the partial liver graft in the abdomen.
