Right Phrenic Nerve Injury in Orthotopic Liver Transplantation

McAlister, Vivian C.; Grant, David; Roy, André; Brown, William F.; Hutton, L; Leasa, David; Ghent, Cameron N.; Veitch, James; Wall, William

doi:10.1097/00007890-199304000-00027

Cited by 63 publications

(39 citation statements)

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“…This phenomenon has been observed even in children with structural pulmonary changes after OLT for cystic fibrosis [30] or alpha-l-antitrypsin deficiency [16]. Our data from long-term survivors eliminate potential confounding variables of the postoperative period, such as impaired motility of the right hemidiaphragm [33] or pleural effusions [23,28,371. Despite a similar prevalence of pleural thickening and interstitial changes in our and other series [28], these abnormalities were not associated with an impairment of ventilation in long-term survivors after OLT.…”

Section: Discussionmentioning

confidence: 57%

High prevalence of pulmonary diffusion abnormalities without interstitial changes in long-term survivors of liver transplantation

Ewert¹,

Mutze²,

Schachschal³

et al. 1999

Transplant International

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Abnormalities in lung function are frequent findings in patients with terminal stage chronic liver disease. While spirometric parameters improve early after liver transplantation, a reduction in diffusion capacity has been reported up to 15 months after transplantation. It is unknown to what extent this disturbance in gas exchange occurs among long term survivors after liver transplantation. We assessed lung function in terms of spirometry, and gas exchange as well as pulmonary morphology by high resolution computed tomography (HRCT) in 40 patients 38 months (median, range 20-147 months) after liver transplantation. The prevalence of restrictive or obstructive changes was not different from predicted values. For the whole group of longterm survivors the carbon monoxide transfer coefficient (KCO) was reduced to 71.3 + 12.0 % predicted ( P < 0.05). HRCT revealed interstitial changes in only 2/40 (5.0 %), emphysematous bullae in 2/40 (5.0 %) and pleural thickening in 9/40 (22,s Yo). Diffusion abnormalities are prevalent in the majority of patients after liver transplantation, whereas spirometric abnormalities are absent also in the long term. The high prevalence of impaired gas exchange and the absence of interstitial lesions imply that changes in pulmonary blood vessels are the most likely cause.

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Section: Discussionmentioning

confidence: 57%

High prevalence of pulmonary diffusion abnormalities without interstitial changes in long-term survivors of liver transplantation

Ewert¹,

Mutze²,

Schachschal³

et al. 1999

Transplant International

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“…Compromise of the phrenic nerve due to the stretching itself, the application of clamps during surgery, or indeed both could also have contributed by ensuring poor functioning of an already stretched and thin hemidiaphragm. McAlister et al 1 found phrenic nerve paralysis in 79% and right diaphragmatic paralysis in 38% of patients after liver transplantation. They also found that the left phrenic nerve was intact in all patients.…”

Section: Discussionmentioning

confidence: 97%

“…Excessive electrocautery on the diaphragm while the liver is being separated from the diaphragm is another potential etiology. 1,3 Diaphragmatic eventration can also result from excessive chronic stretching of the diaphragm. 4 In our patient, the cardiac irritability (SVT) was the result of his liver being displaced into the right hemithorax and compressing the right side of the heart.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The mechanism of injury is most often a crush injury to the phrenic nerve due to the application of a suprahepatic inferior vena cava clamp. 1,3 Most patients who suffer diaphragmatic paralysis at the time of transplantation never develop symptoms. Eventration of the right hemidiaphragm after liver transplantation causing right atrial compression and hemodynamic changes, to our knowledge, has not previously been reported.…”

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confidence: 99%

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Right atrial compression due to diaphragmatic eventration after liver transplantation: Successful treatment by diaphragmatic plication

et al. 2014

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“…In liver transplants, the frequency of right diaphragm paralysis can reach up to 44%. [9][10][11][12][13][14] The diaphragmatic dysfunction may lead to postoperative respiratory complications. The tidal volume and the vital capacity decrease because of the reduced movement of the diaphragm.…”

mentioning

confidence: 99%

Left Hemidiaphragmatic Mobility

Toledo

Kodaira

Massarollo

et al. 2006

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the correlation between the radiographic and ultrasonographic measurements of craniocaudal displacement of the left hemidiaphragm. Methods. Forty-nine patients with clinical indications for interventional procedures prospectively underwent radiographic evaluation of left hemidiaphragmatic mobility and B-mode ultrasonographic measurement of craniocaudal displacement of the hilum and the inferior pole of the spleen. Ultrasonography was performed with a 3.5-MHz convex transducer in a left intercostal position under a longitudinal orientation. Statistical analyses were performed with linear regression, a paired Student t test, and Bland-Altman analyses. Results. The correlation between the craniocaudal splenic hilum displacement and radiographic measurements was found to be linear: hemidiaphragmatic mobility = 17.795 + 0.429 × splenic hilum displacement (SE for the regression coefficient = 0 .12; P = .0012), although the values obtained with both methods were statistically different (P < .05). The same results could be observed with the use of the inferior pole of the spleen: hemidiaphragmatic mobility = 9.5596 + 0.5455 × inferior polo displacement (SE for the regression coefficient = 0 .11; P < .0001). The mean difference between the values obtained by ultrasonography and by radiography was statistically significant (16.7 ± 16.1 mm; P < .05 [hilum]; 18.9 ± 14.2 mm; P < .05 [inferior pole]). Conclusions. These results allow us to conclude that ultrasonography can be used as an alternative method for left hemidiaphragm mobility evaluation compared with radiography.

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Right Phrenic Nerve Injury in Orthotopic Liver Transplantation

Cited by 63 publications

References 0 publications

High prevalence of pulmonary diffusion abnormalities without interstitial changes in long-term survivors of liver transplantation

High prevalence of pulmonary diffusion abnormalities without interstitial changes in long-term survivors of liver transplantation

Right atrial compression due to diaphragmatic eventration after liver transplantation: Successful treatment by diaphragmatic plication

Left Hemidiaphragmatic Mobility

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