Incidence of phrenic neuropathy after isolated lung transplantation. The Loyola University Lung Transplant Group.
BACKGROUND
Isolated lung transplantation is a viable therapeutic option for many patients with end-stage pulmonary disease. Other intrathoracic surgical procedures have a well documented incidence of phrenic nerve dysfunction, although the incidence after lung transplantation has not been studied.


METHODS
Thirty-one patients who underwent lung transplantation were evaluated for evidence of phrenic nerve dysfunction and subsequent recovery. Risk factors contributing to the incidence of injury were examined. Phrenic nerve injury was defined by two separate diagnostic tests (Transcutaneous Phrenic Nerve Conduction Studies and Fluoroscopic evaluation of diaphragmatic movement) used in combination.


RESULTS
Of the 27 patients who were completely evaluated after the operation, eight had defining criteria for nerve injury--an incidence of 29.6%. Of those affected, the majority of injuries (89%) resulted in complete paralysis of the affected hemidiaphragm. The highest incidence of injury occurred in patients who underwent bilateral single lung transplantation (41%), with the right phrenic nerve being injured most often (78%). Fortunately, no significant postoperative morbidity was attributable to the occurrence of phrenic nerve injury when compared with those patients who did not sustain injury.


CONCLUSIONS
The analysis of possible risk factors resulted in the hypothesis that the likely mechanism of injury in these patients was due to stretching or direct instrumentation of the nerve, and thus measures should be instituted to minimize the possibility of injury.
Sheridan
P H
PH
Department of Medicine, Loyola University Medical Center, Maywood, Ill 60153, USA.
Cheriyan
A
A
Doud
J
J
Dornseif
S E
SE
Montoya
A
A
Houck
J
J
Flisak
M E
ME
Walsh
J M
JM
Garrity
E R
ER
D000328:Adult; D004558:Electric Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000502:physiology*; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries* / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D011930:Reaction Time / Q000502:physiology; D012133:Respiratory Paralysis / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D009435:Synaptic Transmission / Q000502:physiology