Diaphragmatic Hernia after Adult Orthotopic Liver Transplantation: A Rare Surgical Complication Associated to Immunosuppression?

Abstract

Diaphragmatic Hernia (DH) after adult Orthotopic Liver Transplantation (OLT) is a rare event with only two cases reported in English literature. It is not clear if this complication is related to surgery or to immunosuppression therapy or both. We describe a well-resolved case of left-sided DH in a 43-year-old man taking Tacrolimus and mycophenolate mofetil (MMF) as immunosuppressants, 27 months after OLT. Authors from previously reported cases considered that ascites and incisional hernia, as well as Mammalian Target Of Rapamycin (mTOR) inhibitors therapy, as predisposing factors for DH development. In the case presented here, none of the possible surgical triggering factors described before were present. MMF is associated to impaired wound healing and incisional hernias, like mTOR inhibitors. Maybe minor and not evident diaphragmatic injury during hepatectomy associated to immunosuppression with mTOR inhibitors and/or MMF have an important role in DH occurrence after OLT in adults.