{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:15:04Z","timestamp":1787004904816,"version":"build-2736575974"},"reference-count":24,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Introduction\u2003Postoperative diaphragmatic hernia (DH) is a rare but potentially life-threatening complication following pediatric liver transplantation (LT). In the current literature, a total of 49 such hernias have been reported in 17 case series. We present eight additional cases, three of which reoccurred after surgical correction, and review the current literature with a focus on recurrence.<\/jats:p>\n                  <jats:p>Materials and Methods\u2003The study sample included children (&lt;18 years of age) who underwent LT between June 2013 and June 2020 at five large transplant centers and who subsequently presented with DH. During the study period, a total of 907 LT was performed. Eight DH were recognized, and risk factors were analyzed.<\/jats:p>\n                  <jats:p>Results\u2003For the eight children with DH, the mean age at LT was 28.0 (5\u2013132) months. All patients with a DH received left lateral segment split grafts except one, who received a full left lobe. The mean weight at time of LT was 11.8 (6.6\u201334) kg. Two patients had a primary abdominal muscle closure, and six had a temporary silastic mesh closure. All eight children presented with a right posterolateral DH. The small bowel was herniated in the majority of cases. Symptoms reported included nausea, vomiting, and respiratory distress. Two patients were asymptomatic, and discovery was incidental. All patients underwent prompt primary surgical repair. Three DH hernias (37.5%) recurred despite successful surgical correction.<\/jats:p>\n                  <jats:p>Conclusion\u2003DH following liver transplant with technical variant grafts may be underreported and is prone to recur despite surgical correction. A better understanding of the pathophysiology and more thorough reporting may help increase awareness. Early detection and prompt surgical management are the cornerstones of a successful outcome.<\/jats:p>","DOI":"10.1055\/s-0040-1716882","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T18:44:02Z","timestamp":1605293042000},"page":"396-406","source":"Crossref","is-referenced-by-count":7,"title":["Diaphragmatic Hernia following Pediatric Liver Transplantation: An Underappreciated Complication Prone to Recur"],"prefix":"10.1055","volume":"31","author":[{"given":"Lea Sibylle","family":"Waldron","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany"},{"name":"Department of Pediatrics, Hospital of the Philipps-University Marburg, Marburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam Cortes","family":"Cerisuelo","sequence":"additional","affiliation":[{"name":"Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Lo","sequence":"additional","affiliation":[{"name":"Emory Transplant Center, Emory University, Atlanta, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blayne Amir","family":"Sayed","sequence":"additional","affiliation":[{"name":"Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Vilca-Melendez","sequence":"additional","affiliation":[{"name":"Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, National Health Service Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Magliocca","sequence":"additional","affiliation":[{"name":"Emory Transplant Center, Emory University, Atlanta, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eberhard","family":"Lurz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology and Nutrition, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximillians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Baumann","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Hannover Medical School, Hannover, Germany"},{"name":"Institute for Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian W. R.","family":"Vondran","sequence":"additional","affiliation":[{"name":"Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Richter","sequence":"additional","affiliation":[{"name":"Department for General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietrich","family":"von Schweinitz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximillians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Guba","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, University Hospital, Ludwig-Maximilians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2790-4395","authenticated-orcid":false,"given":"Oliver J.","family":"Muensterer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany"},{"name":"Department of Pediatric Surgery, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximillians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Dr. von Hauner Children\u2019s Hospital, Ludwig-Maximillians-University, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"issue":"12","key":"ref1","first-page":"1088","article-title":"Early postoperative complications of pediatric liver transplantation","volume":"46","author":"M H Imanieh","year":"2009","journal-title":"Indian Pediatr"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/lt.24180","article-title":"Biliary complications in pediatric liver transplantation: incidence and management over a decade","volume":"21","author":"J M Laurence","year":"2015","journal-title":"Liver Transpl"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/j.1399-3046.2006.00665.x","article-title":"Pediatric liver transplantation in Iran: evaluation of the first 50 cases","volume":"11","author":"S M Dehghani","year":"2007","journal-title":"Pediatr Transplant"},{"issue":"12","key":"ref4","first-page":"1429","article-title":"Diaphragmatic hernia after liver transplantation in children: case series and review of the literature","volume":"20","author":"M Cortes","year":"2014","journal-title":"Liver Transpl"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jamcollsurg.2010.09.017","article-title":"Small bowel obstruction after pediatric liver transplantation: the unusual is the usual","volume":"212","author":"T M Earl","year":"2011","journal-title":"J Am Coll Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1097\/TP.0000000000001121","article-title":"Failure to rescue as a quality improvement approach in transplantation: a first effort to evaluate this tool in pediatric liver transplantation","volume":"100","author":"S L Cramm","year":"2016","journal-title":"Transplantation"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"e13296","DOI":"10.1111\/petr.13296","article-title":"Case series and systematic review of acquired diaphragmatic hernia after liver transplantation","volume":"22","author":"J A Emamaullee","year":"2018","journal-title":"Pediatr Transplant"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"E106","DOI":"10.1111\/j.1399-3046.2010.01462.x","article-title":"Posteromedial diaphragmatic hernia following pediatric liver transplantation","volume":"16","author":"S-B Moon","year":"2012","journal-title":"Pediatr Transplant"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"126","DOI":"10.6061\/clinics\/2015(02)10","article-title":"Effects of ischemic preconditioning in a pig model of large-for-size liver transplantation","volume":"70","author":"A JG Leal","year":"2015","journal-title":"Clinics (S\u00e3o Paulo)"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.jpedsurg.2015.11.019","article-title":"Postsurgical diaphragmatic herniation: a rare delayed complication of pediatric intraabdominal surgery","volume":"51","author":"M Yazdani","year":"2016","journal-title":"J Pediatr Surg"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1007\/s00383-015-3702-3","article-title":"Iatrogenic diaphragmatic hernia in paediatric patients","volume":"31","author":"F Yeung","year":"2015","journal-title":"Pediatr Surg Int"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1111\/j.1399-3046.2006.00658.x","article-title":"Bowel obstruction due to diaphragmatic hernia in an elder child after pediatric liver transplantation","volume":"11","author":"H Okajima","year":"2007","journal-title":"Pediatr Transplant"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"E149","DOI":"10.1111\/petr.12548","article-title":"Acquired right diaphragmatic hernia following pediatric living donor orthotopic liver transplantation","volume":"19","author":"Z D\u00f6k\u00fcmc\u00fc","year":"2015","journal-title":"Pediatr Transplant"},{"issue":"07","key":"ref14","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1016\/j.jpedsurg.2005.03.063","article-title":"Right-sided diaphragmatic hernia in infants after liver transplantation","volume":"40","author":"A J McCabe","year":"2005","journal-title":"J Pediatr Surg"},{"issue":"33","key":"ref15","doi-asserted-by":"crossref","first-page":"e1376","DOI":"10.1097\/MD.0000000000001376","article-title":"Thoracoscopic approach for repair of diaphragmatic hernia occurring after pediatric liver transplant","volume":"94","author":"S Lee","year":"2015","journal-title":"Medicine (Baltimore)"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/01.tp.0000231709.63721.5c","article-title":"Diaphragmatic hernia resulting in enterothorax following pediatric liver transplantation: a rare complication","volume":"82","author":"C Englert","year":"2006","journal-title":"Transplantation"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.1111\/j.1399-3046.2009.01168.x","article-title":"Right-sided diaphragmatic hernia after orthotopic liver transplantation: report of two cases","volume":"14","author":"M Kazimi","year":"2010","journal-title":"Pediatr Transplant"},{"issue":"05","key":"ref18","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/j.1399-3046.2012.01722.x","article-title":"Diaphragmatic hernia in infants following living donor liver transplantation: report of three cases and a review of the literature","volume":"16","author":"T Shigeta","year":"2012","journal-title":"Pediatr Transplant"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"E77","DOI":"10.1111\/petr.12052","article-title":"Right diaphragmatic hernia after liver transplant in pediatrics: a case report and review of the literature","volume":"17","author":"H-D Lam","year":"2013","journal-title":"Pediatr Transplant"},{"issue":"15","key":"ref20","doi-asserted-by":"crossref","first-page":"e0346","DOI":"10.1097\/MD.0000000000010346","article-title":"Acquired diaphragmatic hernia in pediatrics after living donor liver transplantation: three cases report and review of literature","volume":"97","author":"K Wang","year":"2018","journal-title":"Medicine (Baltimore)"},{"issue":"03","key":"ref21","first-page":"337","article-title":"Diaphragmatic hernia after liver transplant in children: report of 2 cases","volume":"16","author":"M H Okur","year":"2018","journal-title":"Exp Clin Transplant"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/MPG.0000000000001792","article-title":"Sarcopenia in children with end-stage liver disease","volume":"66","author":"E Lurz","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jpeds.2017.10.066","article-title":"Frailty in children with liver disease: a prospective multicenter study","volume":"194","author":"E Lurz","year":"2018","journal-title":"J Pediatr"},{"issue":"05","key":"ref24","first-page":"471","article-title":"Diaphragmatic hernia after pediatric liver transplant","volume":"13","author":"M Kirnap","year":"2015","journal-title":"Exp Clin Transplant"}],"container-title":["European Journal of Pediatric Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1716882.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T18:45:53Z","timestamp":1631904353000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1716882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":24,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2021,9,17]]},"published-print":{"date-parts":[[2021,10]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1716882","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0939-7248","1439-359X"],"issn-type":[{"value":"0939-7248","type":"print"},{"value":"1439-359X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,13]]}}}