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Incidence of intra-abdominal hypertension after liver transplantation with temporary portocaval shunt - A prospective cohort.
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Melo Estrella Bianca, Carneiro-D'Albuquerque Luiz Augusto, Andraus Wellington, Pedro Rodolpho Augusto, Scharank Bruna Carla, Mesquita Paula Sepulveda, Waisberg Daniel Reis, de Martino Rodrigo Bronze, Rocha-Santos Vinicius, Ducatti Liliana, Andrade Lucia C, Farias Alberto Queiroz, Malbouisson Luiz Marcelo Sá
Аннотация
BACKGROUND: Intra-Abdominal Hypertension (IAH) is reported to be frequent after liver transplantation. Nonetheless, the evolution of surgical techniques improved postoperative care in the last decades, which could lead to a lower incidence of Intra-abdominal hypertension.
METHODS: The authors prospectively studied 104 patients. The intra-abdominal pressure and abdominal perfusion pressure were measured at the end of surgery and every 6 hours until 72 hours, and patients were divided into two groups: with (IAH+) or without (IAH-) IAH. Outcomes analyzed were death, renal function, reoperation, need for vasopressors, mechanical ventilation, hemodialysis, and graft function measured by indocyanine green.
RESULTS: The incidence of Intra-abdominal hypertension was 14.4%, with no abdominal compartment syndrome cases. After 48 hours, 60% of the IAH+ group was on mechanical ventilation versus 26.7% in the IAH- group (p = 0.016). The prevalence of dialysis at the end of the first postoperative week was higher in the IAH+ group (31.3% vs. 10.8%, p = 0.047). Both groups had similar indocyanine green clearance on the third and seventh postoperative days. Reoperation rates (12.4% vs. 20%), need for retransplant (10.1% vs. 13.3%), and death (14% vs. 18.2%) were similar in IAH- and IAH+ groups, respectively. The number of blood products transfused (OR = 1.18) and body mass index (OR = 1.10) were associated with the development of intra-abdominal hypertension, while intraoperative ascites (OR = 0.19) was a protective factor.
CONCLUSIONS: Intra-abdominal hypertension was present in 14.4% of liver transplant patients, and IAH was linked to a greater need for mechanical ventilation and hemodialysis but not to more reoperations, transplants, or deaths.
METHODS: The authors prospectively studied 104 patients. The intra-abdominal pressure and abdominal perfusion pressure were measured at the end of surgery and every 6 hours until 72 hours, and patients were divided into two groups: with (IAH+) or without (IAH-) IAH. Outcomes analyzed were death, renal function, reoperation, need for vasopressors, mechanical ventilation, hemodialysis, and graft function measured by indocyanine green.
RESULTS: The incidence of Intra-abdominal hypertension was 14.4%, with no abdominal compartment syndrome cases. After 48 hours, 60% of the IAH+ group was on mechanical ventilation versus 26.7% in the IAH- group (p = 0.016). The prevalence of dialysis at the end of the first postoperative week was higher in the IAH+ group (31.3% vs. 10.8%, p = 0.047). Both groups had similar indocyanine green clearance on the third and seventh postoperative days. Reoperation rates (12.4% vs. 20%), need for retransplant (10.1% vs. 13.3%), and death (14% vs. 18.2%) were similar in IAH- and IAH+ groups, respectively. The number of blood products transfused (OR = 1.18) and body mass index (OR = 1.10) were associated with the development of intra-abdominal hypertension, while intraoperative ascites (OR = 0.19) was a protective factor.
CONCLUSIONS: Intra-abdominal hypertension was present in 14.4% of liver transplant patients, and IAH was linked to a greater need for mechanical ventilation and hemodialysis but not to more reoperations, transplants, or deaths.