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Incidence and Risk Factors for Incisional Hernia Development in Liver Transplant Recipients: A Systematic Review and
Vitor Neves1, Denise Padilha Abs de Almeida2, Júlia Apocalypse Rodrigues Cardoso Dos Santos3
1Hospital Universitário dos Servidores do Estado - HUSE-UNIRIO, Rio de Janeiro, Brazil.
Aim:
Incisional hernias (IHs) are a significant source of postoperative morbidity following liver transplants (LTs). Our aim is to perform a comprehensive systematic review and proportional meta-analysis to evaluate the pooled incidence of and risk factors associated with the development of IH following LT.
Methods:
A comprehensive search was conducted using PubMed, Cochrane, Embase, and Web of Science databases. All studies reporting the incidence of IHs following liver LT in adult patients were included. Data were extracted on IH incidence, age, gender, diabetes mellitus diagnosis, body mass index (BMI), Model for End-Stage Liver Disease (MELD) score, presence of ascites, and wound complications in both IH and non-IH cohorts. Statistical analysis was performed using RStudio.
Results:
From 2078 records, 28 studies were included, encompassing 12,354 patients, with 1709 IH reported. Proportional meta-analysis estimated an overall IH incidence of 14.5% (95% confidence interval [CI]: 10.88 to 19.08, I2 = 97%, P < .01) following LT. Risk factor analysis identified male sex (RR: 1.16; 95% CI: 1.08 to 1.24; P < .0001), wound complications (RR: 2.6; 95% CI: 1.35 to 5.07; P = .004), older age (RR: 2.00; 95% CI: 1.20 to 2.85; P < .0001), and high BMI (RR: 0.86; 95% CI: 0.39 to 1.33; P < .0001) as significant predictors of IH development. However, MELD scores, presence of ascites, and diabetes were not significantly associated with IH risk.
Conclusion:
LTs have a pooled IH incidence of 14%. Male sex, high BMI, older age, and post-transplant wound complications are associated with an increased risk of IH development.