A hipertensão intra-abdominal pode influenciar na disfunção do enxerto hepático e função renal nos primeiros três dias de pós-operatório do transplante de fígado

Abstract

Liver graft dysfunction and acute renal failure may be related to intra-abdominal hypertension in the immediate postoperative period of liver transplantation. Objectives: To identify the prevalence of intra-abdominal hypertension in the first three postoperative days of liver transplantation patients; to correlate intra-abdominal hypertension with liver graft dysfunction and renal dysfunction. Material and Method: This is a field study, quantitative, prospective and contemporary. The subjects of the research were patients over 18 years of age, hospitalized in the immediate postoperative condition of liver graft, within the first 72 hours at the Intensive Care Unit, from December 2016 to December 2018, at Hospital de Base in São José do Rio Preto, SP. Initially, the study was approved by the Ethics and Research Committee. Results: A total of73 patients were included and investigated in this study; men were the highest prevalence (73%). Alcohol cirrhosis was present in 34(46%) of the patients; 35(48%) presented IAH. At the first day of ICU staying, the intra-abdominal pressure ranged from 11 to 16 mmHg (p=<0.01). On the second day, it varied from 11 to 17 mmHg (p=<0.01). On the third day it ranged from 10 to 18 mmHg (p=<0.001). From the first to the third postoperative day, the results of the examinations with their respective median values were: AST decreased from 825U/L to 189U/Lin the group that presented IAH. ALT decreased from 655U/L to 318U/L. Total Bilirubin increased from 3.5mg/dL to 4.2mg/dL. Direct Bilirubin increased from 3mg/dL to 3.7mg/dL.Lactate decreased from 3mEq/L to 1.4 mEq/L. Urea increased from 67mg/dL to 97mg/dL. Creatinine increased significantly in the first 24 hours and remained at 1.8 mEq/L until the third day. Of those who evolved to death in the IAH group, there was a greater predominance of septic shock 6(67%), followed by liver graft failure 3(33%) as the cause of death. Conclusion: Presence of IAH in 35 (48%) of the patients who had undergone liver transplantation was found in the immediate postoperative period. The grade II with the respective value of IAP 18mmHg was the remained one. From these patients, the function of the hepatic graft revealed that on the third day, it increased both as direct Bilirubin and total Bilirubin, and in the first 24 hours, creatinine significantly increased characterizing renal dysfunction. No case of Abdominal Compartmental Syndrome was found in this study.