Incisional hernia following liver transplantation: incidence and predisposing factors.
BACKGROUND
Patients after orthotopic liver transplantation (OLT) have a high risk of developing incisional hernia (IH). In the literature incidences between 5% and 17% are reported.


METHODS
In 90 patients, who underwent OLT between October 1998 and December 2005, a retrospective analysis on the occurrence of IH was performed. Surgical access for OLT was a transversal upper laparotomy. Age, gender, primary disease, ICU stay, immunosuppressive regimen and two different closure techniques (running suture or single sutures in layers) were evaluated.


RESULTS
In 73 patients (76.7%, group 2) healing of the incision was without problems, in 17 patients (23.3%, group 1), IH occurred. Total survival was similar between the groups (86.3% vs. 94.1%, n.s.). No significant differences between the groups concerning age, gender, body mass index, platelet count and duration of ICU stay were found. Also, the technique of abdominal closure had no impact on the development of IH. No IH was found in patients with hepatocellular carcinoma (n = 15), whereas end-stage liver cirrhosis (n = 75) was associated with development of IH (p = 0.064). Multivariate analysis revealed end-stage liver cirrhosis, Sirolimus, and MMF to be independent significant risk factors for IH after OLT.


CONCLUSIONS
IH following OLT has to be regarded a frequent complication. While technique of abdominal closure seems to have no impact, primary diagnosis and kind of immunosuppressive regimen exerted a significant influence on the formation of IH.
Kahn
Judith
J
Department of Transplant Surgery, Medical University Graz, University Clinic of Surgery, Graz, Austria. judith.kahn@klinikum-graz.at
Müller
Helmut
H
Iberer
Florian
F
Kniepeiss
Daniela
D
Duller
Doris
D
Rehak
Peter
P
Tscheliessnigg
Karlheinz
K
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D005260:Female; D046449:Hernia, Abdominal / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000276:immunology
D000961:Antilymphocyte Serum