Analysis Of Post Liver Transplantation Complications And Risk Factors For Death And Clinical Research Of Predict Survival Rate By MELD Score And CTP Classification System

Objective: Investigate the risk factors of complications incidence rate andmortality rate after liver transplantation by MELD score and CTPclassification.Evaluation MELD score and CTP classification system for predictionresult of short-term and long-term prognosis after liver transplantation.Methods: Retrospective analysis the clinical data of184patients with end-stageliver disease undergone liver transplantation in Fuzhou General Hospital of Nanjingmilitary command Hepatobiliary Surgery Department by MELD score and CTPclassification from January2008to January2013.184patients were divided intocomplications and non-complications group, survival group and the death group. Bystatistical analysis preoperative and intraoperative clinical indicators. Investigate therisk factors of complications incidence rate and mortality rate after livertransplantation.Measure the MELD score and CTP classification to predict short-termand long-term prognosis in patients with end-stage liver disease undergone livertransplantation by the area under receiver operator characteristic (ROC) curve.Evaluation MELD score and CTP classification system for prediction result ofshort-term and long-term prognosis after liver transplantation. Kaplan-Meier survivalcurves were made using the cutoffs identified by ROC curve.The different survivalrates were analyzed by Log-rank test.Main Results:1、Comparison of three groups A（MELD≤10）、B(MELD＞10,≤20）、C（MELD＞20）preoperative and intraoperative clinical indicators, significant difference in Cr、PT、PT-INR、TBIL、intraoperative average urine volume、intraoperative bloodtransfusion and blood loss (P<0.05). Comparison of three groups a（CTP5-6）、b（CTP7-9）、c（CTP10-15）preoperative and intraoperative clinical indicators, significantdifference in ALB、PT、PT-INR、TBIL、intraoperative average urine volume、intraoperative blood transfusion and blood loss(P<0.05). 2、Comparison of three groups A、B、C of the incidence of postoperativecomplications,significant difference in abdominal cavity bleeding、gastrointestinalbleeding、pulmonary infection、abdominal infection、renal failure、rejection、neuropsychopathic complications(P<0.05). Comparison of three groups a、 b、c,significant difference in abdominal cavity bleeding、abdominal infection、renalfailure、neuropsychopathic complications (P<0.05).3、The complication group and the non-complication group single factor analysissignificant in PT、TBIL、CTP score、MELD score、Cr、intraoperative average urinevolume、intraoperative blood transfusion and blood loss (P<0.05). The two groups inage、gender difference was not statistically significant(P>0.05). Multivariate analysisshowed that high total bilirubin in the preoperative and intraoperative bloodtransfusion increased are the risk factors for complications after liver transplantation(P<0.05).4、Clinical indicator comparison between the10kinds of complications in Cr、intraoperative average urine volume、operation time were significantly difference (P<0.05).5、Comparison of three groups A、B、C in3months,6months,1-year survivalrate were significant difference (P<0.01), but no significant difference in the2-yearsurvival (P>0.05).Comparison of three groups a、b、c in3months,6months,1-year,2-year survival rate were significant difference (P<0.01), but no significantdifference in the2-year survival (P>0.05).6、Kaplan-Meier survival curves were made using MELD and CTP score cutoffidentified by ROC curve,significant difference in the different survival rates wereanalyzed by Log-rank test (P<0.05).7、The death group and survival group single factor analysis significant in TBIL、PT-INR、PT、CTP score、MELD score、Cr、operative time、intraoperative averageurine volume、intraoperative blood transfusion and blood loss(P<0.05). But in age andgender were not significant difference.Multivariate analysis showed that preoperativePT increased、high MELD score、intraoperative blood transfusion increased andintraoperative average urine volume decreased were the risk factors for mortality rateafter liver transplantation (P<0.05). Conclusions:1、The higher the MELD score and CTP classification, significantly highermortality rate and the incidence of complications after liver transplantation.2、MELD score were superior to CTP score to predict the incidence ofcomplications after liver transplantation, especially in distinguish on renal function.3、Hyperbilirubinemia、Coagulation function and renal function is not goodbefore the operation is the most important risk factors for complications after livertransplantation.4、Both MELD score and CTP classification system could predict prognosis in3months,6months,1-year survival rate after liver transplantation,and CTP score weresuperior to MELD score in3months,6months.CTP score could predict long-termprognosis（more than1-year）after liver transplantation, But MELD score can not.5、PT increased,high MELD score, intraoperative blood transfusion volumeincreased and intraoperative average urine volume decreased were the risk factors fordeath after liver transplantation.