Evaluation of the Behavior of Intraabdominal Pressure and Incidence of Intraabdominal Hypertension in Patients Undergoing Liver Transplantation.

• Grant number: 16/20062-9
• Support Opportunities: Regular Research Grants
• Start date: February 01, 2017
• End date: January 31, 2019
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Luiz Augusto Carneiro D'Albuquerque
• Grantee: Luiz Augusto Carneiro D'Albuquerque
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Alberto Queiroz Farias ; Estrella Bianca de Mello ; Flair José Carrilho ; Lucia da Conceição Andrade ; Luiz Marcelo Sá Malbouisson ; Wellington Andraus

Abstract

Abstract Background: Little information is available on the dynamics of intraabdominal pressure (IAP) and its actual incidence after liver transplantation (LT). The pathological increase in this pressure, also referred to as intraabdominal hypertension (IAH), can lead to a derangement of tissue perfusion, thereby ultimately developing end-organ dysfunction, being characterized by the abdominal compartment syndrome (ACS). Both clinical entities are associated with significant morbidity and mortality in postsurgical and critically ill patients. Therefore, the evaluation of IAP in the perioperative period of LT is of paramount importance.Objectives: The primary aim of this prospective study is to evaluate the IAP behavior in the perioperative period of patients undergoing LT since their admission just before surgery until the seventh postoperative day. Secondly, this study will also evaluate the incidence of IAH/ ACS in these patients of the University of São Paulo hospital, at the Gastroenterology Intensive Care Unit (ICU). In third place, the relationship among the indocyanine green plasma disappearance rate (ICGPDR), new organ dysfunction/ failure and the behavior of IAP after LT will be analyzed as well. Methods: This study is observational, prospective and single-center. One hundred consecutive patients undergoing LT will be enrolled, regardless of their reasons for transplantation. The IAP will be measured at the operating room (OR) after anesthesia induction, after closing the abdominal wall at the end of the surgery and every six hours until the seventh postoperative day. A closed system for intravesical intermittent measurement will be used in order to avoid infection. Blood and urine samples will be collected daily for laboratory analysis. Clinical variables will be also recorded. ICGPDR measurements will be assessed on postoperative days 3 and 7, using a noninvasive device. Exclusion criteria include patients submitted to peritoneostomy because of surgical complications, once the IAP equals the atmospheric pressure in these specific cases. Moreover, patients who have known allergies to iodine or evidence of thyroid diseases are not eligible either.Statistics: Data will be expressed as mean ± SD, median (interquartile range) or as percentage (number). Comparisons between the groups with and without IAH will be performed using Student t test, Wilcoxon test or chi-square test, according to the distribution. Temporal analysis of continuous variables will be performed using One-way or Two-way ANOVA for repeated measures when indicated. P values < 0.05 will be considered statistically significant. Statistical results will be performed using SPSS 20.0 (SPSS, Chicago, IL, USA). (AU)