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Response Regarding: Incisional Hernia After Liver Transplant: A Population-Level Retrospective Cohort Analysis.

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Incisional Hernia After Liver Transplant: A Population-Level Retrospective Cohort Analysis.

Elizabeth A Swanson1, Jyothi R Thumma2, Christina M Fleischer2

  • 1Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, Oregon Health & Science University, Portland, Oregon.

The Journal of Surgical Research
|March 20, 2026
PubMed
Summary

Incisional hernia is a common complication after liver transplant. This study found a 5-year incidence of 27.2%, with significant variation between transplant centers, highlighting areas for quality improvement.

Keywords:
Hernia repairIncisional herniaLiver transplantationTransplant centersVentral hernia

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Area of Science:

  • Hepatology
  • Abdominal Surgery
  • Transplant Surgery

Background:

  • Incisional hernia is a frequent complication following liver transplantation.
  • The contemporary incidence of incisional hernia in liver transplant recipients is not well-established.

Purpose of the Study:

  • To determine the incidence of incisional hernia after liver transplant in a national cohort.
  • To evaluate variations in incisional hernia incidence across different liver transplant centers.

Main Methods:

  • Retrospective cohort study using Medicare fee-for-service claims (2016-2021).
  • Estimated cumulative incidence of incisional hernia repair as an indicator of true incidence.
  • Utilized risk- and reliability-adjusted models considering patient demographics, comorbidities, and transplant year.

Main Results:

  • The study included 14,417 liver transplant recipients.
  • The 5-year cumulative incidence of incisional hernia repair was 6.8%, estimating an actual incisional hernia incidence of 27.2%.
  • A 2.8-fold variation in 5-year incisional hernia repair rates was observed across transplant centers (2.9% to 8.3%).

Conclusions:

  • Incisional hernia remains a significant post-liver transplant complication.
  • Observed variations in incidence across centers suggest potential for quality improvement initiatives.
  • Identifying best practices at low-incidence centers could reduce incisional hernia rates.