Evaluation of the behavior of intra-abdominal pressure and the incidence of intra-abdominal hypertension in patients undergoing liver transplantation

Author(s)

Estrella Bianca de Mello

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2021-10-15

Examining board members

Luiz Augusto Carneiro D Albuquerque; Ilka de Fatima Santana Ferreira Boin; Luciana Bertocco de Paiva Haddad; Luiz Marcelo Sá Malbouisson

• Advisor: Luiz Augusto Carneiro D Albuquerque

Abstract

Introduction: intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with organ dysfunctions, including acute kidney injury (AKI) and risk of death after liver transplantation. A better understanding of the pathophysiology of IAH has resulted in a reduction in intra-abdominal pressure (IAP) and, therefore, in a reduction in the incidence of IAH. The objective of this study was to evaluate the behavior of IAP and its clinical repercussions in the first days after liver transplantation. Methods: a total of 104 patients undergoing liver transplantation were evaluated within seven days after surgery. After induction of anesthesia, a bladder catheter connected to a closed IAP measurement system was inserted through the intrabladder and zeroed at the mid-axillary line. The IAP, mean arterial pressure (MAP) and abdominal perfusion pressure (APP) were measured at the end of surgery and every 6 hours in the first 72 hours in patients with a closed abdominal cavity. To assess outcomes, patients were classified into two groups: with (IAH+) or without (IAH-) intra-abdominal hypertension. The following were evaluated: liver function, renal function, need for vasopressors, mechanical ventilation and hemodialysis. On the 3rd and 7th postoperative days (POD), liver uptake of indocyanine green (ICG) was analyzed by the LiMON® method. Results: the incidence of IAH in this study was 14.4%, without cases of ACS. Seventy patients had some degree of renal dysfunction, 12 in the IAH+ group and 58 in the IAH- group (p = 0.355). 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, with 31.3% vs. 10.8% IAH- (p = 0.047). The ICG clearance at 3 POD and 7 POD was similar in the IAH+ and IAH- groups. The rates of reoperation (12.4% vs. 20%), retransplantation (10.1% vs. 13.3%) and death (14% vs. 18.2%) were similar in the IAH- and IAH+ groups, respectively. Conclusions: in the present study, the incidence of IAH was low, and no ACS was observed. However, the presence of intra-abdominal hypertension was associated with a greater need for mechanical ventilation and hemodialysis. Despite this, it was not associated with a greater need for reoperation, retransplantation or a higher death rate (AU)

• FAPESP's process: 16/18394-3 - Evaluation of the behavior of intra-abdominal pressure and incidence of intra-abdominal hypertension in patients undergoing liver transplantation
• Grantee: Estrella Bianca de Mello
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)