Liver transplantation is just as successful in infants as in older children, but more challenging. This relates to the low weight of the recipients and to their rapidly deteriorating clinical condition (
malnutrition and
end-stage liver disease) ( J Pediatr 1990;117:205-210; BMJ 1993;307:825-828; Ann Surg 1996;223:658-664;
Transplantation 1997;64:242-248; J Pediatr Surg 1998;33:20-23). In addition, higher rates of diaphragmatic complications have been shown to significantly correlate with a younger age (
Transplantation 2002;73:228-232; Transpl Int 1998;11:281-283; Pediatr Transplant 2000;4:39-44), but
diaphragmatic hernia has never been reported as a complication of
liver transplantation. In this report, 2 patients who developed
diaphragmatic hernia after
liver transplantation are presented. The possible role of several contributing factors resulting in
diaphragmatic hernia is discussed. These factors include (1) diaphragm
thinness related to low weight and
malnutrition, (2) direct
trauma at operation (dissection and
diathermy), (3) increased abdominal pressure after
transplantation caused by the use of a slightly oversized liver graft, and (4) the medial positioning of the partial liver graft in the abdomen.