Incidence and risk factors for recurrence of incisional hernia repair after liver transplantation: a retrospective cohort study

TL;DR

This study found that longer hospital stays and certain repair types increase the risk of incisional hernia recurrence after liver transplants.

Contribution

This is the first study to assess body composition as a risk factor for incisional hernia recurrence in liver transplant patients.

Findings

35.1% of liver transplant recipients developed incisional hernias after a median follow-up of 75.87 months.

35.4% of those with hernias experienced recurrence, with longer hospital stays and suture-based repairs as significant risk factors.

Visceral obesity showed a trend toward increasing recurrence risk, though it was not statistically significant.

Abstract

The objective of this study was to evaluate the incidence and identify risk factors associated with the recurrence of incisional hernia (IH) following initial parietal repair in patients who had undergone liver transplantation. Liver transplantation (LT) is a complex procedure associated with numerous complications, particularly those affecting the abdominal wall, with incisional hernia (IH) being the most significant. To date, the risk factors contributing to IH recurrence in this population have not been systematically assessed.

This retrospective, single-center study included all patients who underwent liver transplantation at Rennes University Hospital between January 1, 2012, and December 31, 2018. The list of eligible patients was provided by the French Biomedicine Agency.

A total of 803 liver transplant recipients were included. Among them, 282 patients (35.1%) developed an incisional hernia (IH) after a median follow-up of 75.87 months [54.7–97.2]. Of these, 50 patients (35.4%) experienced IH recurrence at a median interval of 8.8 months [5.2–34.2] following primary repair. Identified risk factors for recurrence included: length of hospital stay after the initial repair (HR: 1.09 [1.09–1.13], P = < 0.0001), type of repair (suture versus prosthetic) (HR: 2.48 [1.25–4.9], P = 0.009). Visceral obesity is considered a high-risk factor (HR: 2.21 [0.98–4.95], P = 0.055), although the association no longer reached the conventional threshold for statistical significance.”

To the best of our knowledge, this is the first study to assess body composition as a risk factor for incisional hernia recurrence in the liver transplant population. These findings highlight the importance of considering visceral obesity as a significant predictor of recurrence.

The online version contains supplementary material available at 10.1007/s10029-025-03400-0.