American Review of Respiratory Medicine - Volumen 25, Número 1 - March 2025

Editorials

Evaluation of Diaphragmatic Function Before and After a Liver Transplant

Evaluación de la función diafragmática antes y después de un trasplante hepático

“Genius is 1% inspiration and 99% perspira­tion.”

Thomas Edison

Liver transplantation is currently the only defini­tive treatment for patients with acute liver failure and end-stage liver cirrhosis. However, poor pre­operative clinical conditions of recipients and the complexity of the surgical procedure make pulmo­nary complications a significant challenge in the postoperative management of these patients. The complications affect short- and long-term survival, hospital stay, and quality of life.^1-3

The authors of this study address one of the relevant pulmonary complications in the context of liver transplants, diaphragmatic dysfunction, and the evolution of respiratory parameters after surgery. To do so, they decided to innovate by us­ing diaphragmatic ultrasound before and after the transplantation so as to evaluate diaphragmatic excursion and thickening fraction over time. It is worth noting that the use of diaphragmatic ultra­sound in Intensive Care Units has been increasing in recent years, for the purpose of doing real-time monitoring of the function and behavior of the main inspiratory muscle in patients who are on mechanical ventilation (MV). However, its use­fulness as a predictor of successful weaning from MV is still under debate.⁴ In addition, researchers complemented this evaluation by measuring the forced vital capacity (FVC) with a hand-held analog ventilometer.

The findings of the study show that the decrease in FVC (42.44%) and diaphragmatic excursion (30.01%) in the immediate postoperative period is significant, and this could possibly be related to the fact that it is an upper abdominal surgery and to the clamping mechanism of the suprahepatic infe­rior vena cava along the path of the right phrenic nerve during the procedure, which restricts the diaphragmatic excursion. These results highlight the need for close respiratory monitoring and re­spiratory rehabilitation during this stage.

Even though the study provides valuable pre­liminary information, it has some limitations:

• The use of the ventilometer: though it is a simple, portable, low-cost device, it is less ac­curate compared to the spirometer.

• Sample size: the small size of the sample (a se­ries of 7 patients) limits the robustness of the conclusions.

• The influence of the internal environment on the respiratory function in these patients was not assessed.

However, this study can be the starting point for multicenter research with larger samples to con­firm these findings and explore early therapeutic interventions, such as respiratory physiotherapy, in order to mitigate the adverse respiratory effects, optimize the functional recovery of these patients and shorten hospital stay.

Conflict of interest

The authors have no conflicts of interest to declare.

REFERENCES

1. Feltracco P, Carollo C, Barbieri S, Pettenuzzo T, Ori C. Early respiratory complications after liver transplantation. World J Gastroenterol. 2013;19:9271-81. https://doi.org/10.3748/wjg.v19.i48.9271

2. Ghatas TS, Elfaizy MW. Respiratory Complications in Chronic Liver Disease Patients Before and After Liver Trans­plantation at Al Sahel Teaching Hospital. Al-Azhar Intl Med J 2023;4:37-46. https://doi.org/10.58675/2682-339X.1748

3. Levesque E, Hoti E, Azoulay D, Honore I, Guignard B, Vibert E, et al. Pulmonary complications after elective liver transplantation-incidence, risk factors, and outcome. Transplantation 2012;94:532-8. https://doi.org/10.1097/TP.0b013e31825c1d41

4. Cuba Naranjo A, Sosa Remón A, Pérez Yero Y, Jeréz Alvarez A, Auza-Santivañez C, Díaz Águil C. Rev. Diaphragmatic ultrasound in critically ill patients: usefulness in different clinical scenarios. Chil Anest. 2025;54:111-9. https://doi.org/10.25237/revchilanestv54n2-02