Increased intra-abdominal pressure linked to worse long-term prognosis among patients with orthotopic liver transplantation: a retrospective, observational study.

Abstract

Objective: To investigate the prognostic value of intra-abdominal pressure (IAP) among patients with orthotopic liver transplantation (OLT).

Patients: We enrolled adult patients admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University after undergoing liver transplantation from January 2018 to March 2022.

Methods and results: A total of 382 patients were included, with 73 patients who died within 1 year after admission. Intra-abdominal Hypertension (IAH) was defined as a sustained IAP ≥ 12 mmHg. The incidence of IAH among liver transplant patients was 46.2%. The IAP and sequential organ failure assessment (SOFA) scores were significantly lower in survivors than non-survivors (P < 0.05). Restricted cubic spline (RCS) analysis found that an IAP level above 16 mmHg was significantly associated with an elevated risk of 1-year mortality, and Kaplan-Meier survival curves further validated this finding (log-rank P < 0.001). Multivariate Cox proportional hazards regression model indicated that patients in IAH grade III (HR: 3.16, 95% CI: 1.31-7.62, P = 0.010) and IV (HR: 9.93, 95% CI: 2.84-34.7, P < 0.001) had significantly higher 1-year mortality risks adjusted by SOFA score classifications compared to individuals without IAH. Maximum IAP levels alone and a modified SOFA score incorporating IAH grade demonstrated satisfactory performance in predicting in-hospital mortality among OLT patients (AUC: 0.710, 0.834, respectively).

Conclusions: Elevated intra-abdominal pressure above 16 mmHg was significantly related with worse 1-year survival among OLT patients. Both maximum IAP alone and SOFA score incorporated with IAH components showed strong prognostic values for in-hospital mortality of these individuals.