Risk Factors for Surgical Site Occurrence or Infection and Recurrence After Incisional Hernia Repair in Abdominal Transplant Population

Transplant Proc. 2021 Mar;53(2):762-767. doi: 10.1016/j.transproceed.2021.01.014. Epub 2021 Feb 4.


Purpose: To investigate risk factors for hernia recurrence, surgical site occurrence/infection (SSO/I) and those requiring procedural intervention (SSOPI) after incisional hernia repair (IHR) following abdominal transplantation.

Methods: Patients undergoing IHR following abdominal transplant were retrospectively identified in the Americas Hernia Society Quality Collaborative database. Primary outcome measures were SSO/I, SSOPI and hernia recurrence.

Results: There was a total of 166 patients. Seventeen patients (10%) had an SSO/I at 30 days. Overall complication rate was 26%, and there was 1 mortality (1%). Composite recurrence rate was 28% (21/75) over 2 years. In univariate analysis, history of diabetes (DM), body mass index (BMI) >35 kg/m2, and history of open abdomen were associated with SSO/I (P < .05). Immunosuppression had a negative correlation with SSO/Is and SSOPIs. BMI >35 kg/m2 was associated with 180-day recurrence, whereas history of hypertension remained significant for recurrence at 2 years (P < .05).

Conclusion: History of an open abdomen, DM, and obesity are risk factors for SSO/I, and obesity and hypertension are associated with short-term and long-term recurrence after IHR following abdominal organ transplantation. Immunosuppression had negative correlation with SSO/I. However, long-term outcomes and those related to immunosuppression should be interpreted cautiously in view of the small sample size and low follow-up rates. Baseline comorbidities seem to be the main drive for hernia outcomes for transplant population, similar to the general population. Larger cohorts and longer follow-up are necessary to delineate preventable risk factors for SSO/Is and hernia recurrences after organ transplantation.

MeSH terms

  • Adult
  • Aged
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Female
  • Hernia, Abdominal / complications*
  • Hernia, Abdominal / etiology
  • Hernia, Abdominal / surgery*
  • Herniorrhaphy
  • Humans
  • Incisional Hernia / complications*
  • Incisional Hernia / etiology
  • Incisional Hernia / surgery*
  • Male
  • Middle Aged
  • Obesity / epidemiology
  • Organ Transplantation / adverse effects*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Surgical Wound Infection / epidemiology