Does anhepatic phase duration affect diaphragmatic hernia after pediatric liver transplantation? A single-center experience analyzed from a pool of nearly 2000 cases.

BACKGROUND

Diaphragmatic hernia (DH) is one of the rare complications without the confirmed risk factors following pediatric liver transplantation (pLT).

PURPOSE: To analyze the clinical characteristics and risk factors of DH after pLT.

METHODS

A retrospective analysis of 15 DH cases after pLT among 1,863 cases of pLT from January 2014 to June 2024 was conducted. Using propensity score matching (PSM), DH patients (n = 15) were matched 1:3 with non-DH recipients (n = 45). DH cases were stratified into early-onset (≤ 3 months, n = 6) and late-onset (> 3 months, n = 9) groups according to the interval from LT surgery to DH diagnosis. Comparative analyses were performed to characterize DH and identify risk factors.

RESULTS

DH incidence was approximately 0.8% in our cohort, with most of cases within 12 months post-pLT. The clinical features of DH were primarily digestive or respiratory symptoms, and prognosis was favourable after repairing surgery. After PSM, the DH and non-DH groups were well balanced with respect to baseline covariates. Compared to non-DH recipients, DH patients had longer time in both anhepatic phase and ICU stay duration (P < 0.05). Late-onset DH patients had longer anhepatic and operative times than early-onset patients (P < 0.05). No significant differences were found in growth parameters between DH and non-DH groups, and DH defect locations or GRWR between early-onset and late-onset groups.

CONCLUSION

Despite low incidence, DH post- pLT is a multi-factorial complication, and re-operation is necessary for all cases. Prolonged anhepatic phase may be a risk factor. Preventive measures, such as meticulous intraoperative manipulation, expedited surgical procedures, and the minimization of iatrogenic injuries, should be conscientiously adopted in pLT.