Comparative Study Of The MELD And MELD-Na Scores In Evaluating The Short-term Prognosis Of Liver Transplantation In Patients With Liver Failure

Background:Liver failure is a serious liver disease syndrome with high mortality.Under the action of various factors,the synthesis,metabolism,bile secretion and excretion,coagulation function,biochemical transformation function and immune function of the liver are impaired,resulting in hepatic encephalopathy,hypoproteinemia,ascites,coagulation dysfunction,jaundice and other clinical symptoms.At present,liver transplantation is an effective treatment for liver failure.However,China is a big country with liver disease,the number of patients with liver disease in China is large,the demand for liver transplantation is large,and the number of patients waiting for transplantation is gradually increasing.In addition,due to the disappearance of standard criteria donor,the influence of Chinese traditional culture and religious beliefs lead to organ shortage,and the cost of transplantation and other factors also greatly limit the development of liver transplantation,resulting in an increase in the ratio of supply and demand.Therefore,in the face of such limited resources,we still need to explore how to standardize the selection of recipients and how to improve the survival rate of patients after transplantation.Early death after liver transplantation is the main factor affecting the overall survival of liver transplantation patients.Within 3months after liver transplantation,the survival rate of patients decreased most significantly,and then the survival rate of transplant patients gradually tended to be stable.At present,the scores for the evaluation of preoperative systemic condition and postoperative survival rate of liver transplant patients are model for end-stage liver disease(MELD)and MELD-Na score of end-stage liver disease model,but there are relatively few comparative studies on the early survival rate of liver failure patients after liver transplantation,so this paper mainly observes the relationship between MELD and MELD-Na score and early prognosis of liver transplantation patients with liver failure,to evaluate the timing of operation in patients with liver failure,to provide reference for the rational distribution of the liver,to explore the relevant risk factors of early death after liver transplantation,to identify critically ill patients and carry out early prevention and treatment for such patients as early as possible,and to improve the short-term prognosis and the overall prognosis of patients undergoing liver transplantation.Objective: To explore the relationship between MELD score and MELD-Na score on the early(3 months)prognosis of liver failure patients undergoing liver transplantation,and to explore the related risk factors of early death after liver transplantation.Methods: The preoperative and intraoperative clinical data of 86 patients with liver failure undergoing liver transplantation in our hospital were collected.Univariate and multivariate Cox regression analysis the risk factors for early postoperative prognosis.The distinguishing ability of MELD and MELD-Na scores for early prognosis was evaluated by receiver operating characteristic curve(ROC),and the best cut-off value was determined according to Youden index.Results: Of the 86 patients,there were 21 patients(24.4%)of early death died in the short-term after liver transplantation.Preoperative MELD score(P=0.001)and intraoperative blood transfusion volume(P<0.001)were independent index of liver transplantation in patients with liver failure.The AUC of MELD and MELD-Na scores for predicting the short-term prognosis were 0.696 and 0.686 respectively,with no statistical significance between two AUCs(P=0.677).The early survival rates of MELD≥24.3 group and MELD<24.3 group were 51.7%(15/29)and 87.7%(50/57),respectively(P<0.001);The early survival rates of MELD-Na≥25.7 group and MELD-Na < 25.7 group were 54.9%(17/31)和 87.3%(48/55),respectively(P<0.001).When the MELD score and MELD-Na score increased,the early survival rates decreased.Conclusion: There was no significant difference between MELD score and MELD-Na score in predicting the short-term survival rate of liver failure after liver transplantation.When MELD ≥ 24.3 or MELD-Na ≥ 25.7,the mortality rate within 3 months after operation is relatively high.