Postoperative Renal Impairment is Associated with Increased Length of Stay for Incisional Hernia Repair after Liver Transplantation
19 Pages Posted: 23 Apr 2019 Publication Status: Under Review
Abstract
Background: Incisional hernia repair (IHR) is the most common procedure after orthotopic liver transplantation (OLT). Although enhanced recovery protocols are increasingly employed, the post-OLT patient may not benefit from all aspects of these models. The aim of the present study is to assess which perioperative interventions and patient factors effect hospital length of stay in a cohort of post-OLT patients undergoing IHR.
Methods: We conducted a retrospective review of a series of adult patients undergoing IHR after OLT. The primary endpoint was length of stay. Results were stratified by demographic, intraoperative, and postoperative variables.
Results: 172/1523 (11%) patients who received OLT during the study period underwent subsequent IHR. Median length of stay was 5 days (range 2-50). The strongest predictor of length of stay was postoperative renal function. Despite liberal intraoperative administration of volume (median 642 ml/hr) and brisk intraoperative urine output (median 72ml/hr), postoperative acute kidney injury (AKI) occurred in 48% of patients. Those that developed AKI received less intraoperative volume (6 ml/kg/hr vs 8.5 ml/kg/hr; p=0.031) and the severity of postoperative renal injury was inversely related to intraoperative volume.
Conclusions: In patients undergoing IHR after OLT, postoperative renal function is frequently impaired. This finding is likely owed to the enterohepatic circulation of nephrotoxic immunosuppression. Although many aspects of current ERAS protocols may be applied to post-transplant patients, restrictive intraoperative fluid administration strategies should be employed with caution given a high propensity for the development of post-operative AKI in this complex population.
Keywords: Liver transplant, Incisional Hernia, Renal Injury, ERAS
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