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The impaired diaphragmatic function after bilateral lung transplantation: A multifactorial longitudinal study
Antonella LoMauro1, Ilaria Righi2, Emilia Privitera2
1Dipartimento di Elettronica, Informazione e Bioingegneria. Politecnico di Milano, Milan, Italy; Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
Lung transplantation can cause temporary diaphragmatic dysfunction, impacting breathing mechanics. This dysfunction typically resolves within a year, highlighting the need for post-operative diaphragmatic function assessment.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Nephrology
Background:
- Lung transplantation is a vital treatment for end-stage pulmonary disease.
- Phrenic nerve injury and diaphragmatic dysfunction are known but under-described post-operative complications.
- This study investigates the impact of lung transplantation on diaphragmatic function.
Purpose of the Study:
- To assess diaphragmatic function changes after lung transplantation.
- To identify the specific aspects of diaphragmatic function affected by the procedure.
- To correlate diaphragmatic dysfunction with potential surgical causes.
Main Methods:
- A multimodal approach was used to evaluate diaphragmatic function in 30 patients.
- Measurements included geometry, weakness, force, mobility, contractility, electrical activity, and kinematics.
- Data were collected pre-operatively, at discharge, and at 6 and 12 months post-surgery.
Main Results:
- Despite clinical recovery, diaphragmatic function was reduced at discharge and 6 months post-transplant.
- Dysfunction was evident in force, weakness, electrical activity, and kinematics.
- Full recovery of diaphragmatic function was observed at 1 year, suggesting phrenic nerve neurapraxia or axonotmesis.
Conclusions:
- Diaphragmatic dysfunction occurs post-lung transplantation even with good clinical recovery.
- Phrenic nerve injury is a likely cause, potentially due to surgical techniques.
- Routine assessment of diaphragmatic function should be incorporated into post-operative care.
