Study On Predicting Short-term Prognosis In Patients Undergone Liver Transplantation

Various types of hepatitis, liver cirrhosis, liver cancer, congenital and metabolic liver diseases, etc., resulting in liver damage irreversibly, eventually develop into end-stage liver disease. This problem severely distresses to people's health. With the continual development of modern surgery, organ preservation and perioperative management technology, as well as the rapid development of transplant immunology and molecular biology, liver transplantation (LT) has gradually become the only effective treatment of end-stage liver disease. However, liver transplantation would not be widely carried out because of lack of the donors. Although the pro-donor liver, living donor liver, marginal donor liver to some extent alleviate the shortage of donors, the contradiction between the increasing number of patients waiting for LT and the shortage of donors has become more and more apparent. With a huge troop of patients waiting for LT, that how we rationally allocate the limited donors and maximize their effectiveness is the one of significant problems which should be solved right now.With the general development of LT and relative clinical researches, experts find that the survival rate and quality of life in patients undergone liver transplant are considerable aspects that should be taken into account in the processing of the organs being allocated. The patient with the severest degree of end-stage liver disease has the priority of LT, however, the mortality rate after operation would be increasing. This not only causes wasting the limited donors and property, but also neutralizes the advantages on the virtue of the reduction of the mortality rate before surgery by the increasing mortality rate after operation. For this, experts need a credible standard to assess the severity of liver diseases. The standard to evaluate patients'death risk in the waiting process and ascertain the priority of LT, was Child-Turcotte-Pugh (CTP) score initially, now has been replaced by model for end-stage liver disease (MELD) scoring. However, MELD scoring has also some drawbacks, which can not assure that the donors are allocated fairly and rationally. In recent years, researchers have found that MELD with incorporation of sodium(MELD-Na) scoring predicting death risk in the waiting process is more accurate. An ideal liver allocation model should not only allocate livers to patients with the highest probability of dying before LT, but should also be able to predict which candidates have the lowest post-LT predicted mortality in order to improve utility. It is regretting that there is not a scientific, objective and precise standard now.Objective This study aims to compare the predictive values of preoperative CTP score, MELD score and MELD-Na scoring on the short-term (≤3 months) prognosis in patients with end-stage liver disease after liver transplantation, analyze the preoperative indicators, only to seek the preoperative indicators that can accurately predict the short-term outcome in patients undergone LT, with the reference to the practice of clinical liver transplantation.Materials and Methods We analyzed retrospectively the clinical data of 73 patients with end-stage liver disease undergone liver transplantation in our department from January 2003 to December 2008. We calculated separately preoperative CTP score, MELD score and MELD-Na scoring of each patient. The ability of preoperative CTP score, MELD score and MELD-Na scoring to predict short-term prognosis in patients with end-stage liver disease undergone liver transplantation was measured by the area under receiver operator characteristic (ROC) curve respectively, and their differences were also analyzed statistically. The differences of the short-term mortality rates among different grading groups were analyzed by the means ofχ2 test. According to patients'short-term prognosis after operation,73 patients were divided into two groups:survival group and death group.14 preoperative indicators of clinical and laboratory examinations were analyzed. After some preoperative indicators were quantified assignments respectively,14 preoperative indicators were analyzed by the method of Logistic multiple regression analysis. Statistical processing package was SAS 9.1.3 soft. The difference was statistically significant with P<0.05.Results 11 of 73 patients died within 3 months after LT (the mortality rate: 15.1%). The area under the ROC curve of preoperative CTP score, MELD score and MELD-Na scoring predicting 3 months short-term survival in 73 patients with end-stage liver disease undergone liver transplantation was 0.817,0.839 and 0.860 respectively, and the differences were of no statistical significance. The differences of the short-term mortality rates among different grading groups were statistically significant. According to the results of Univariate analysis, the differences of preoperative serum sodium, blood urea nitrogen, prothrombin time international normalized ratio (PT-INR), CTP score, MELD score and MELD-Na scoring were statistically significant. On the base of the results of Logistic multiple regression analysis, however, only preoperative MELD-Na scoring for short-term prognosis was of statistical significance (P= 0.001).Conclusions 1) Preoperative CTP score, MELD score and MELD-Na scoring are all able to well predict the short-term outcome in patients with end-stage liver disease undergone liver transplantation.2) Preoperative high MELD-Na scoring is an independent risk factor for short-term survival in patients after operation. Higher the score is, the death risk of post-transplantation short-term outcome is higher. In a word, MELD-Na scoring system can well predict the short-term outcome in patients undergone liver transplantation and guide the allocation of the limited donors fairly and reasonably. However, its clinical value will be identified by the huge samples studies in the future.