Evaluation of Induction Immunosuppression and Risk of Incisional Hernia After Liver Transplantation

被引:0
作者
Kim, Yun Ji [1 ]
Wlodarczyk, Jordan [2 ]
Ding, Li [2 ]
Carey, Joseph [2 ]
Emamaullee, Juliet [2 ]
Zielsdorf, Shannon [2 ]
机构
[1] Univ Southern Calif, Keck Sch Med, 1975 Zonal Ave, Los Angeles, CA 90033 USA
[2] Univ Southern Calif, Dept Surg, Los Angeles, CA USA
基金
美国国家卫生研究院;
关键词
Basiliximab; Corticosteroid; Immunosuppression induction; Incisional hernia; Liver transplantation; Risk factor; SURGICAL-TREATMENT;
D O I
10.1016/j.jss.2024.02.006
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: Liver transplantation (LT) is a technically complex operation and usually performed on ill patients. A major postoperative morbidity is incisional hernia, occurring in 9.5%-32.4% of cases. There are mixed results in transplant studies regarding potential risk factors. Additionally, the literature is lacking in the relationship between specific immunosuppressive induction agents administered during LT and postoperative incisional hernia. Methods: A single center, retrospective cohort study of patients who underwent primary LT between 4/2011-1/2018 was conducted. Clinical variables including demographics and comorbidities were reviewed. The primary end point was the development of an incisional hernia following LT. Sub analysis was performed for secondary end points to determine potential risk factors, including immunosuppressive induction agent. Results: Overall, 418 patients met inclusion criteria. At 5 y post -LT, there were 66/271 (24.4%) and 53/147 (36.1%) patients diagnosed with an incisional hernia in the methylprednisolone and basiliximab groups, respectively. After propensity score matching, there was no difference in incisional hernia development between induction agents, P = 0.19. For patients with body mass index >= 30 and postoperative seroma of the abdominal wall, the hazard ratios were 2.67 (95% CI = 1.7, 4.3) and 2.03 (95% CI = 1.1, 3.9), respectively. Conclusions: Incisional hernia rate after LT was 28.5% at 5 y. Our analysis found that immunosuppressive induction agent at LT was not associated with the development of postoperative incisional hernia. However, preoperative obesity (body mass index >= 30) and postoperative seroma of the abdominal wall were potential risk factors. Further studies are needed to delineate if these risk factors remain across institutions and in alternative settings. (c) 2024 Elsevier Inc. All rights reserved.
引用
收藏
页码:18 / 25
页数:8
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