title: Early use of mammalian target of rapamycin inhibitors is an independent risk factor for incisional hernia development after liver transplantation.
abstract: Incisional hernias (IHs) are common complications after liver transplantation (LT) with a reported incidence of 1.7% to 34.3%. The purpose of this retrospective study was to evaluate the risk factors for IH development after LT with a focus on the role of immunosuppressive therapy during the first month after LT. We analyzed 373 patients who underwent LT and divided them into 2 groups according to their postoperative course: an IH group (121 patients or 32.4%) and a no-IH group (252 patients or 67.6%). A univariate analysis demonstrated that the following were risk factors related to IH development: male sex (P = 0.03), a body mass index ≥ 29 kg/m(2) (P = 0.005), LT after 2004 (P = 0.02), a Model for End-Stage Liver Disease (MELD) score ≥ 22 (P = 0.01), and hepatitis B virus infection (P = 0.01). The highest incidence of IHs was found in patients treated with mammalian target of rapamycin (mTOR) inhibitors (54.5%, P = 0.004). A multivariate analysis revealed male sex (P = 0.03), a pretransplant MELD score ≥ 22 (P = 0.04), and the use of mTOR inhibitors (P = 0.001) to be independent risk factors for IHs after LT. In conclusion, immunosuppressive therapy with mTOR inhibitors is an important independent risk factor for IH development after LT. To reduce the incidence of IHs, mTOR inhibitors should be avoided until the fourth month after LT unless their use is deemed to be strictly necessary.
authors: Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy. robertomontalti@yahoo.it
authors: Roberto
authors: R
authors: Montalti
authors: Antonio
authors: A
authors: Mimmo
authors: Gianluca
authors: G
authors: Rompianesi
authors: Valentina
authors: V
authors: Serra
authors: Nicola
authors: N
authors: Cautero
authors: Roberto
authors: R
authors: Ballarin
authors: Nicola
authors: N
authors: De Ruvo
authors: Robert
authors: R
authors: Cunningham Gerring
authors: Giorgio
authors: G
authors: Enrico Gerunda
authors: Fabrizio
authors: F
authors: Di Benedetto
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007558:Italy; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases