# Incidence of intra-abdominal hypertension after liver transplantation with temporary portocaval shunt – A prospective cohort

## TL;DR

This study found that intra-abdominal hypertension after liver transplants is relatively rare and linked to increased need for ventilation and dialysis.

## Contribution

The study reports updated incidence of intra-abdominal hypertension in liver transplant patients and its clinical associations.

## Key findings

- Intra-abdominal hypertension occurred in 14.4% of liver transplant patients.
- Patients with IAH required more mechanical ventilation and hemodialysis.
- No cases of abdominal compartment syndrome were observed.

## Abstract

•The incidence of intrabdominal hypertension was low in this study.•IAH was linked to a greater need for mechanical ventilation.•IAH was linked to a greater need for hemodialysis.•No cases of abdominal compartment syndrome were observed.

The incidence of intrabdominal hypertension was low in this study.

IAH was linked to a greater need for mechanical ventilation.

IAH was linked to a greater need for hemodialysis.

No cases of abdominal compartment syndrome were observed.

Intra-Abdominal Hypertension (IAH) is reported to be frequent after liver transplantation. Nonetheless, the evolution of surgical techniques improved postoperative care in the last decades, which could lead to a lower incidence of Intra-abdominal hypertension.

The authors prospectively studied 104 patients. The intra-abdominal pressure and abdominal perfusion pressure were measured at the end of surgery and every 6 hours until 72 hours, and patients were divided into two groups: with (IAH+) or without (IAH-) IAH. Outcomes analyzed were death, renal function, reoperation, need for vasopressors, mechanical ventilation, hemodialysis, and graft function measured by indocyanine green.

The incidence of Intra-abdominal hypertension was 14.4%, with no abdominal compartment syndrome cases. After 48 hours, 60% of the IAH+ group was on mechanical ventilation versus 26.7% in the IAH- group (p = 0.016). The prevalence of dialysis at the end of the first postoperative week was higher in the IAH+ group (31.3% vs. 10.8%, p = 0.047). Both groups had similar indocyanine green clearance on the third and seventh postoperative days. Reoperation rates (12.4% vs. 20%), need for retransplant (10.1% vs. 13.3%), and death (14% vs. 18.2%) were similar in IAH- and IAH+ groups, respectively. The number of blood products transfused (OR = 1.18) and body mass index (OR = 1.10) were associated with the development of intra-abdominal hypertension, while intraoperative ascites (OR = 0.19) was a protective factor.

Intra-abdominal hypertension was present in 14.4% of liver transplant patients, and IAH was linked to a greater need for mechanical ventilation and hemodialysis but not to more reoperations, transplants, or deaths.