Intra-abdominal hypertension, fluid balance, and adverse outcomes after orthotopic liver transplantation.

Abstract

Intra-abdominal hypertension (IAH) is frequently encountered in critically ill surgical patients. We aimed to evaluate the incidence of IAH after orthotopic liver transplant (OLT) and its impact on organ function, hospital length-of-stay (LOS), and death. This prospective, observational, cohort study evaluated consecutive adult patients admitted in the ICU after undergoing OLT. Intra-abdominal pressure (IAP) was measured every 4-6h for 3days. Worsening IAP was defined as a gradual increase in IAP over a period of time. Daily fluid balance was the daily sum of all intakes minus the output. IAH was observed in 48% of the patients within the first 3days after ICU admission, while ACS was diagnosed in 15%. Patients with IAH had a higher positive fluid balance at day 1 (1764mL [812-2733mL] vs. 1301mL [241-1904mL], p=0.025). Worsening IAH was associated with fewer days free of organ dysfunction. IAH within 72h after ICU admission was independently associated with a composite outcome of death or a longer ICU LOS (odds ratio 2.9; CI 95% 1.02-8.25, p=0.043). After OLT, nearly half of the patients presented IAH, that was associated with unfavorable outcomes.