Post-Abdominal Transplant Hernia: What Increases Risk?
Brooks J. Knighton, B.S., Ledibabari M. Ngaage, MA Cantab MB BChir, Yvonne M. Rasko, M.D..
University of Maryland School of Medicine, Baltimore, MD, USA.
Purpose: Abdominal organ transplant is a life-saving treatment for numerous conditions. However, the resultant weakening of the abdominal muscle leaves patients susceptible to post-transplant incisional abdominal hernia, which can have significant impacts on quality of life. Obesity, smoking, and diabetes mellitus have been identified as risk factors in post-transplant hernia. However, to date no studies have investigated the relationship between hernia risk factors and hernia severity in the transplant population.Methods: We performed a retrospective chart review of all post-abdominal transplant hernia patients since 2012 at a single academic institution. We collected details on patient demographics, transplant operation, hernia repair, and post-repair complications. Hernia size was used as a proxy for severity. Interquartile ranges (IQR) are reported with median values. Standard deviations (SD) are reported with mean values.
Results: 31 patients were identified with a near equal representation by gender (M=48%, n=15; F=52%, n=16). The average patient was 56 years old (IQR: 47-63) and obese (BMI 30.6 ±6.3). Smoking (38%, n=14) and diabetes (52%, n=16) were also prevalent within the cohort. Four transplant types were represented within our cohort (renal n=30; simultaneous pancreas-kidney n=5; liver n=1; simultaneous kidney-liver n=1). Two-thirds of patients experienced a complication after hernia repair (63%, n=19) and 16% required re-operation. The median time from transplant surgery to hernia occurrence was 53 months (IQR:12.5-110). The presence of risk factors (obesity, smoking or diabetes mellitus) did not significantly shorten the time interval between transplant and hernia occurrence nor were they associated with increased hernia size.
Conclusion: Obesity, smoking, and diabetes mellitus are not prognostic of severity of post-transplant incisional hernia. However, due to their association with hernial occurrence, providers should consider further precautions during initial transplant. Large cohort studies would be valuable for determining predictive factors of severity of hernia and its association with surgical methods.
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