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Background <p>Diaphragmatic hernia (DH) is one of the rare complications without the confirmed risk factors following pediatric liver transplantation (pLT).</p> Purpose <p>To analyze the clinical characteristics and risk factors of DH after pLT.</p> Methods <p>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 (<i>n</i> = 15) were matched 1:3 with non-DH recipients (<i>n</i> = 45). DH cases were stratified into early-onset (≤ 3 months, <i>n</i> = 6) and late-onset (&gt; 3 months, <i>n</i> = 9) groups according to the interval from LT surgery to DH diagnosis. Comparative analyses were performed to characterize DH and identify risk factors.</p> Results <p>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 (<i>P</i> &lt; 0.05). Late-onset DH patients had longer anhepatic and operative times than early-onset patients (<i>P</i> &lt; 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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2026年5月24日

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  • Zhenyang Mou,
  • Chong Dong,
  • Chao Sun,
  • Weiping Zheng,
  • Yang Yang,
  • Zhen Wang,
  • Chao Han,
  • Enbo Xie,
  • Guofeng Zhang,
  • Kai Wang,
  • Wei Gao

摘要

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.