INCIDENCE OF PHRENIC NEUROPATHY AFTER ISOLATED LUNG TRANSPLANTATION

Background: Isolated lung transplantation is a viable therapeutic opti on for many patients with end-stage pulmonary disease. Other intrathor acic surgical procedures have a well documented incidence of phrenic n erve dysfunction, although the incidence after lung transplantation ha s not been studied. Methods: Thirty-one patients who underwent lung tr ansplantation were evaluated for evidence of phrenic nerve dysfunction and subsequent recovery. Risk factors contributing to the incidence o f injury were examined. Phrenic nerve injury was defined by two separa te diagnostic tests (Transcutaneous Phrenic Nerve Conduction Studies a nd Fluoroscopic evaluation of diaphragmatic movement) used in combinat ion. Results: Of the 27 patients who were completely evaluated after t he operation, eight had defining criteria for nerve injury-an incidenc e of 29.6%. Of those affected, the majority of injuries (89%) resulted in complete paralysis of the affected hemidiaphragm. The highest inci dence of injury occurred in patients who underwent bilateral single lu ng transplantation (41%), with the right phrenic nerve being injured m ost often (78%). Fortunately, no significant postoperative morbidity w as attributable to the occurrence of phrenic nerve injury when compare d with those patients who did not sustain injury. Conclusions: The ana lysis of possible risk factors resulted in the hypothesis that the lik ely mechanism of injury in these patients was due to stretching or dir ect instrumentation of the nerve, and thus measures should be institut ed to minimize the possibility of injury.