Right diaphragmatic paralysis following orthotopic liver transplantation

Although most postoperative complications of liver transplantation are well known and their pathophysiology is reasonably understood, right diaphragmatic dysfunction occurring after liver transplantation remains an unappreciated complication. To evaluate the incidence and mechanisms responsible for such injury, a group of 48 liver transplant patients were studied prospectively. Partial right diaphragmatic paralysis was found in 11 (23%), complete paralysis was found in 10 (21%) and the remaining 27 patients had normal diaphragmatic motion (56%). The operative records of these 48 patients were reviewed. Right diaphragmatic injury was found to be a common postoperative complication of liver transplantation. Moreover, it was found to have a clinically significant effect upon the postoperative course of these patients, often necessitating a prolonged ICU stay and prolonged ventilatory support. Although the exact mechanism responsible for its occurrence remains speculative, careful attention to operative technique particularly in the dissection of the upper cava and careful closure of the bare area of the diaphragm, may reduce the frequency of this untoward complication.