RIGHT DIAPHRAGMATIC PARALYSIS AFTER LIVER -TRANSPLANTATION

Right hemidiaphragm paralysis has been previously documented in patien ts after orthotopic liver transplantation (OLT) and it may contribute to the development of postoperative pulmonary problems. It has been po stulated that a crush injury to the right phrenic nerve during OLT is the cause of dysfunction of the right hemidiaphragm. To assess the inc idence and effect of right phrenic nerve injury after OLT, we prospect ively studied 51 adult liver recipients that we compared with twelve p atients who underwent liver resection (LR) without suprahepatic vena c ava clamping. We studied the diaphragm excursion by ultrasound, the pu lmonary function tests and the transcutaneous phrenic nerve conduction . Right phrenic nerve injury and hemidiaphragm paralysis occurred resp ectively in 79 % and 38 % of the liver recipients but not after LR. Co nduction along the right phrenic nerve was absent in 53 % of the patie nts and reduced in another 26 %. Left phrenic nerve conduction and lef t hemidiaphragm excursion were normal in both groups. Liver recipients with no conduction in the right phrenic nerve had a significantly gre ater decrease in vital capacity in the supine position compared to tho se with some conduction (29 % vs 14 %; P < 0.001). However, neither th e time on the ventilator or the hospital stay were significantly diffe rent between the two groups. Complete recovery of phrenic nerve conduc tion and diaphragm function may take up to nine months. Right phrenic nerve injury is common after OLT and causes right hemidiaphragm dysfun ction.