Liver Transplant and Incisional Hernia: What Do We Know and What Can We Improve.

Background: During follow-up, incisional hernias can reduce the quality of life of transplant recipients. The objective was to analyze the incidence of incisional hernia and risk factors to detect improvements.

Methods: Retrospective study of transplant recipients between 2002 and 2021. The diagnosis of incisional hernia was clinical and/or radiological. Demographic variables, risk factors, and incisional hernias were studied. Absolute and relative frequency measures have been calculated for qualitative variables and central tendency and dispersion in cases of numerical ones. A multivariate study was performed to identify incisional hernia predictors.

Results: We selected 400 patients, 101 (25.3%) who developed hernia. Fifty-one (72.9%) were not clinically diagnosed. Multivariate analysis revealed that overweight (hazard ratio [HR] 1.36; 95% CI 0.72-2.56), obesity (HR 2.36; 95% CI 1.26-4.42), transfusion platelet (3% increase per concentrate), smoking history (HR 1.71; 95% CI 0.99-2.964), immunosuppression induction with everolimus (HR 4.43; 95% CI 1.61-12.16), and maintenance with sirolimus (HR 2.34; 95% CI 1.21-4.52) were risk factors for developing incisional hernia.

Conclusions: The wide interval of incidence of incisional hernia reflects diagnostic inconsistencies. Incisional hernias should be known by clinicians and patients due to their possible complications. There are significant risk factors related to unhealthy lifestyle habits that are modifiable. Carrying out "small bites" as a closure technique could improve the results. Patients with other no-modifiable factors should be closely followed up. Incisional hernia is frequent and underdiagnosed. Healthy lifestyle habits should be promoted and corrected. Patients with non-modifiable factors should be closely monitored.