Risk Factors for Incisional Hernia Recurrence and Surgical Site Infection in the Transplant Population

O. Andacoglu¹, U. Ozbek², F. Cheema¹, L. Sanchez¹, F. Malcher¹

¹General Surgery, Montefiore Medical Center, Bronx, NY, ²Population Health Science and Policy, Icahn School of Medicine Mount Sinai, New York, NY

Meeting: 2020 American Transplant Congress

Abstract number: A-107

Keywords: Outcome, Recurrence, Risk factors, Surgical complications

Session Information

Session Name: Poster Session A: Surgical Issues (Open, Minimally Invasive):All Organs

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: To investigate recurrence and surgical site infection (SSI) rates and risk factors after incisional hernia (IH) repair following abdominal transplantation.

*Methods: A retrospective review of patients who underwent IH repair following abdominal transplantation at our institution was performed. Primary outcomes were IH recurrence and SSI as defined per the CDC.

*Results: There were 78 patients who underwent IH repair and there were 110 IH surgeries. Baseline patient and surgical characteristics are shown in Tables 1 and 2. There were no significant differences between age, BMI and comorbidities between recurrence and non-recurrence groups. Recurrence rate was 35% (n=24) and SSI rate was 15% (n=12) (Table 3). Multiple hernia repair was the only factor strongly associated with recurrence (p<0.05) (Table 4). None of the analyzed factors had an association with SSI.

*Conclusions: In this study, multiple IH repair is the only factor strongly associated with IH recurrence after abdominal organ transplantation. Once an IH recurred, it was with near certainty that another IH repair would fail again. Therefore, choosing personalized approaches is the most critical component in IH repair in transplant patients. Randomized studies with a larger cohort are necessary to improve the findings of this study.

Table 1. Patient baseline characteristics.
Characteristic	Value
Sex, female, n (%)	30 (73)
Age, years, mean + SD	53 + 12.5
Mean BMI, kg/m², mean + SD	29.6 + 6
Current smoker, n (%)	3 (4)
Hypertension, n (%)	64 (80)
Diabetes Mellitus, n (%)	33 (41)
CKD Stage III or higher, n (%)	42 (53)

Table 2. Surgical characteristics.
Characteristic	n (%)
Transplant type — Kidney; Liver; Combined	35 (44); 41 (51); 4 (5)
IH repair type — Open; Laparoscopic	86 (83); 17 (17)
Mesh type — No Mesh; Biologic only; Synthetic only; Biologic and synthetic	3 (4); 26 (33); 40 (50); 11 (14)
Major abdominal surgery prior to transplant	51 (64)
Take-backs post-transplant	38 (48)
Multiple hernia repair	16 (20)
Emergency hernia repair	17 (21)

Table 3. Outcomes of IH repairs
Outcome	n (%)
SSI	12 (15)
Recurrence	24 (35)

Table 4. Percent recurrence for different variables.
Variable	Percent recurrence	p-value
Kidney transplant	38%	0.621
Re-do transplants	4%	0.430
Pre-transplant surgery	58%	1.000
Take-backs post-transplant	42%	0.932
Multiple hernia repair	92%	0.000
Mesh type in first IH repair; Synthetic; Biologic	42%; 54%	0.621
Emergency hernia repair	42%	0.105

To cite this abstract in AMA style:

Andacoglu O, Ozbek U, Cheema F, Sanchez L, Malcher F. Risk Factors for Incisional Hernia Recurrence and Surgical Site Infection in the Transplant Population [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-incisional-hernia-recurrence-and-surgical-site-infection-in-the-transplant-population/. Accessed May 9, 2025.

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