Intra-abdominal pressure monitoring in liver transplant recipients: a prospective study.
OBJECTIVE
No data are available on the incidence and clinical relevance of increased intra-abdominal pressure after orthotopic liver transplantation. This study assessed abdominal hypertension in a population of transplanted patients as this may be an important cofactor in early postoperative complications.


METHODS
Prospective clinical study in an intensive care unit of a national health system teaching hospital


METHODS
Abdominal pressure was measured every 6 h using the urinary bladder method and was considered elevated when it was 25 mmHg or higher. Hemodynamic status was evaluated at the same times. Renal function was assessed on the basis of hourly urinary output by calculating serum creatinine on postoperative days 2 and 4 and the filtration gradient; patient outcomes were also considered.


RESULTS
Intra-abdominal hypertension was observed in 32% of cases; the subjects with high abdominal pressure had significantly lower mean artery pressure values but did not differ in terms of central venous pressure or cardiac output. High intra-abdominal pressure was more frequently associated with renal failure, a lower filtration gradient, delayed postsurgical weaning from ventilation, and a worse outcome.


CONCLUSIONS
Abdominal hypertension is frequent after liver transplantation and may be associated with a complicated post-operative course.
Biancofiore
Gianni
G
Department No 1 of Anesthesia and Intensive Care, Post-surgical and Transplant ICU, Azienda Ospedaliera Pisana, Ospedale di Cisanello, Via Paradisa 2, 56100 Pisa, Italy. g.biancofiore@med.unipi.it
Bindi
Maria L
ML
Romanelli
Anna Maria
AM
Boldrini
Antonella
A
Consani
Giovanni
G
Bisà
Massimo
M
Filipponi
Franco
F
Vagelli
Antonio
A
Mosca
Franco
F
D000005:Abdomen / Q000503:physiopathology*; D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D007558:Italy / Q000453:epidemiology; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D018709:Statistics, Nonparametric