[Show abstract][Hide abstract] ABSTRACT: Background:
Incisional hernia after liver transplantation is a common complication with an incidence between 5% and 34%. This prospective study analyzed risk factors, surgical management and long-term results after hernia repair.
Material and methods:
From February 2002 until August 2009, 810 liver transplantations were performed. 77 patients (9.5%) underwent incisional hernia repair after a median time of 21.1 months (4.6-76.7) following transplant. These patients were compared to patients without hernia (n=733).
No statistically significant differences between the groups were observed with respect to gender, underlying liver disease, Child-Pugh classification, MELD-Score and preoperative renal failure (p=NS). Multivariate analysis revealed advanced age (p=0.014), body mass index (p=0.016), and re-laparotomies (p<0.001) as independent risk factors for incisional hernias. Pre-existing diabetes mellitus and immunosuppression with mycophenolate mofetil reached significance only in the univariate analysis (p<0.001). Recurrent hernia was observed in 12 of 77 patients (15.6%) at a median time of 7.9 months (4.8-46.8) after primary surgical repair. The recurrence rate after intraperitoneal onlay mesh implantation was lower compared to other mesh techniques (7.7% vs. 21.4%).
The risk factors for the development of incisional hernias in liver transplant patients are similar to patients with prior abdominal surgery for other reasons. Intraperitoneal onlay mesh implantation may lead to a decrease of hernia recurrences. The role of immunosuppression in the genesis of incisional hernias requires further elucidation.
[Show abstract][Hide abstract] ABSTRACT: Given the current organ shortage, an accurate assessment of the patient's outcome after orthotopic liver transplantation (OLTX) for fulminant hepatic failure (FHF) is crucial in order to determine the suitability for transplantation. The purpose of this study was to assess whether APACHE II and III scores would provide prognosis of posttransplant mortality.
The study included 129 patients with FHF who underwent OLTX between 1988 and 2008. APACHE II and III scores were calculated one day before transplantation and correlated with postoperative mortality. The cohort consisted of 42 males and 87 females with a mean age of 32 ± 17 years.
Gender, age and etiology of FHF did not correlate with posttransplant survival (p=NS). The APACHE II score was not significantly higher amongst 30-day non-survivors (p = NS). Both patients who died during this period had a significantly higher APACHE III score compared to survivors (82 ± 19.4 vs. 62 ± 18, p<0.01). Patients with an APACHE III score > 68 had a significantly higher mortality rate (p<0.01). Cox regression analysis revealed the APACHE III score as a significant predictor of death (p<0.001). Each additional point in the APACHE III system raises the postoperative mortality by 3.1%.
The major advantage of the APACHE III score is that its application and prognostic ability is independent from etiology of FHF. This accurate and reproducible evaluation system could be useful to identify patients with poor outcome.
No preview · Article · Mar 2011 · Annals of transplantation: quarterly of the Polish Transplantation Society