Risk factors and nomogram prediction of postoperative incisional hernia following liver transplantation: A retrospective cohort study

BACKGROUND Incisional hernia (IH) is one of the most common complications after liver transplantation, significantly affecting patients’ quality of life and long-term prognosis. However, its risk factors and predictive models remain insufficiently investigated. This study aimed to identify independent risk factors for IH using univariate and multivariate Cox regression analyses and to construct a nomogram prediction model, thereby providing evidence for clinical risk assessment and management. AIM To identify the independent risk factors for postoperative IH following liver transplantation and to develop a Cox regression-based nomogram for individualized risk prediction. METHODS This single-center retrospective cohort study included 511 liver transplant recipients, with a median follow-up duration of 24 months (from January 2019 to December 2021), including demographic characteristics, comorbidities, and preoperative laboratory parameters. Univariate and multivariate Cox regression models were used to analyze factors associated with IH, and a nomogram was developed accordingly. Model discrimination and predictive performance were assessed by the concordance index and risk stratification analysis. RESULTS Univariate analysis showed that age, hepatitis, chronic obstructive pulmonary disease, ascites, malignancy as the transplant indication, history of abdominal surgery, red blood cell count, white blood cell count, serum albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, and international normalized ratio were significantly associated with IH (P < 0.05). Multivariate analysis identified age [hazard ratio (HR) = 1.131, 95% confidence interval (CI): 1.075-1.191, P < 0.001], hepatitis (HR = 2.225, 95%CI: 1.058-4.682, P = 0.035), ascites (HR = 5.687, 95%CI: 1.925-16.802, P = 0.002), serum albumin (HR = 0.933, 95%CI: 0.886-0.982, P = 0.008), elevated alanine aminotransferase (HR = 1.013, 95%CI: 1.004-1.021, P = 0.003), elevated aspartate aminotransferase (HR = 0.996, 95%CI: 0.993-0.999, P = 0.023), and prolonged prothrombin time (HR = 0.903, 95%CI: 0.816-0.999, P = 0.047) as independent risk factors. The nomogram based on these variables showed good discriminative ability (concordance index = 0.874) and effectively predicted the 3- and 5-year risk of IH after transplantation. The median follow-up period and reported cumulative IH incidence: 3-year incidence 12.7%, 5-year incidence 15.1%. Risk stratification further demonstrated that patients in the high-risk group had a significantly higher incidence of IH compared with the low-risk group. CONCLUSION Hepatitis, ascites, hypoalbuminemia, impaired liver function, and coagulation abnormalities are key risk factors for IH following liver transplantation. The nomogram developed in this study demonstrated high accuracy and clinical utility, providing a valuable tool for individualized postoperative management and preventive strategies.