Postoperative outcomes in transplant patients undergoing ventral hernia repair

Transplant patients undergoing ventral hernia repair are classified as Ventral Hernia Working Group 2, indicating higher risk for adverse outcomes. This study assessed perioperative outcomes in transplant patients undergoing ventral hernia repair compared to a case-matched cohort of non-transplant patients.

A retrospective review was conducted using a prospectively maintained database of patients who underwent ventral hernia repair between January 2018 and March 2024. Inclusion criteria included prior liver, kidney, heart, lung, or islet cell transplant patients. A 1:1 case-match was performed. Primary outcomes included 30-day complications and hernia recurrence at a mean follow-up of 13 months.

In total, 253 patients were included. Thirty-two transplant patients were matched to 32 patients in the control group. No difference was observed in 30-day postoperative complications including SSOs (p = 0.13) and SSIs (p = 0.16). The hernia recurrence rate was 12.1 and 3.0% in the transplant and non-transplant cohorts, respectively (p = 0.16). In the transplant cohort alone, hernia recurrence was higher in patients receiving absorbable mesh compared to non-absorbable mesh (23.1% vs. 2.9%, p = 0.06), non-midline versus midline hernias (25.0% vs. 0.0%, p = 0.02), and patients on sirolimus or other immunosuppression medications versus tacrolimus (40.0% vs. 15.4% vs. 0.0%, p = 0.01). Two of the recurrences were bridged repairs.

In our study we did not observe increased risk of adverse outcomes in midline hernia repairs in transplant patients. However, non-midline ventral hernias significantly impact ventral hernia outcomes in transplant patients. In a case-matched cohort, there was no increased rates of SSI or SSO in transplant patients compared to nontransplant patients, but hernia recurrence rates were higher in the transplant cohort.