[Right diaphragmatic paralysis after liver transplantation]

Area of Science:

• Neurosurgery
• Pulmonology
• Transplantation Medicine

Background:

• Right hemidiaphragm paralysis is a known complication post-orthotopic liver transplantation (OLT), potentially causing pulmonary issues.
• A crush injury to the right phrenic nerve during OLT is hypothesized as the cause of this diaphragmatic dysfunction.

Purpose of the Study:

• To prospectively assess the incidence and impact of right phrenic nerve injury following OLT.
• To compare OLT recipients with liver resection (LR) patients to evaluate the specificity of the injury.

Main Methods:

• Prospective study of 51 adult liver recipients and 12 liver resection patients.
• Assessed diaphragm excursion via ultrasound, pulmonary function tests, and transcutaneous phrenic nerve conduction.
• Compared outcomes between OLT and LR groups, and between OLT patients with and without phrenic nerve conduction.

Main Results:

• Right phrenic nerve injury occurred in 79% and hemidiaphragm paralysis in 38% of OLT recipients; neither was observed after LR.
• Complete absence of right phrenic nerve conduction was found in 53% of OLT patients, with reduced conduction in another 26%.
• OLT patients with absent right phrenic nerve conduction showed a significantly greater decrease in vital capacity (29% vs 14%).

Conclusions:

• Right phrenic nerve injury is a frequent occurrence after OLT, resulting in right hemidiaphragm dysfunction.
• This dysfunction can lead to significant reductions in vital capacity.
• Full recovery of phrenic nerve conduction and diaphragm function may require up to nine months post-transplantation.