Nakanishi Keita, Hillebrand Caroline, Schweiger Thomas, Schwarz Stefan, Taghavi Shahrokh, Jaksch Peter, Benazzo Alberto, Chen-Yoshikawa Toyofumi Fengshi, Hoetzenecker Konrad
Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Transpl Int. 2025 Jul 30;38:14691. doi: 10.3389/ti.2025.14691. eCollection 2025.
A rare but important complication after lung transplantation (LTx) is postoperative phrenic nerve dysfunction (PND). Diaphragmatic plication (DP) is a well-established treatment option for PND, however, the long-term effect of PND and DP on lung function parameters and survival after LTx are currently unknown. We retrospectively reviewed 1400 LTx recipients transplanted at Medical University of Vienna between 01/2003 and 12/2022. Fluoroscopy and/or phrenic nerve conduction studies confirmed PND when chest radiographs after extubation showed a unilateral heightened diaphragm. We identified 25 patients with post-operative PND, of whom 12 underwent DP. The remaining 1,375 patients served as a control group. Median ICU-stay and hospital-stay were significantly longer in the PND groups (DP: 20 and 57 days; non-DP: 27 and 43 days; control group: 7 and 25 days; = 0.001/ < 0.001). PND led to consistently lower %TLC in lung function tests performed within the first three years after LTx. DP was associated with lower %FEV1.0 early after LTx but it aligned to %FEV1.0 of the other groups during follow-up. Although PND significantly affected postoperative recovery after LTx, it did not impair long-term survival outcomes.
肺移植（LTx）术后一种罕见但重要的并发症是术后膈神经功能障碍（PND）。膈肌折叠术（DP）是治疗PND的一种成熟治疗选择，然而，目前尚不清楚PND和DP对LTx术后肺功能参数和生存率的长期影响。我们回顾性分析了2003年1月至2022年12月在维也纳医科大学接受LTx的1400例受者。当拔管后的胸部X线片显示单侧膈肌抬高时，通过荧光透视和/或膈神经传导研究确诊为PND。我们确定了25例术后发生PND的患者，其中12例接受了DP。其余1375例患者作为对照组。PND组（DP组：20天和57天；非DP组：27天和43天；对照组：7天和25天；P = 0.001/<0.001）的ICU住院时间和住院时间中位数明显更长。PND导致LTx术后头三年内进行的肺功能测试中%TLC持续降低。DP与LTx术后早期较低的%FEV1.0相关，但在随访期间与其他组的%FEV1.0一致。尽管PND显著影响LTx术后的恢复，但它并未损害长期生存结果。
