| Background: With the improvement of surgical technique, immune inhibitorapplication progress, organ preservation, and the development of perioperativemanagement, as well as the rapid development of the clinical liver implantology,transplantation immunology, liver transplantation has been acknowledged to be themost effective method for the treatment of serious liver disease. And recovery aftertransplantation in patients with infections becomes even the main cause of death inpatients with. Incidence of infection is common complications after livertransplantation,.50~68%of the total number of liver transplant recipients are relatedwith pulmonary infection, abdominal cavity infection, biliary infection, commoncatheter-related sepsis.With extensive liver transplant, the contradiction between the shortage of donorliver and liver transplant patients is more and more prominent,.Therefore, every yearthere are a lot of death in patients during liver waiting period. In order to reduce thetreat liver mortality, it has been recommended to the Child-Turcotte-Pugh (CTP)score as entering the United States to decide to patients with advanced cirrhosis of theliver organ sharing (UNOS) network liver transplant candidates list order standard[1].As a result of the CTP score index subjectivity is stronger and more difficult toaccurately predict90%late year survival rate of patients with liver cirrhosis,2001Kamath puts forward a new evaluation system, such as the model for end-stage liverdisease (model for end-stage liver diseases, MELD). They initially put MELDsuccessfully use to evaluate the short-term survival rate of patients with cirrhosis afterTIPS, later found out that judgment in patients during the period of stay withend-stage liver short-term risk of death was better than CTP score[2]. But wheater theMELD score can be used to predict mortality after liver transplantation or not, thereare big arguments.In view of most of patients with end-stage liver transplant recipients are infectiveof hepatitis b in our country, but abroad diffrent, this article discusses MELD score and the relationship between the infection and the recent survival after transplantation,through the retrospective analysis of various clinical data of end-stage liver diseasebefore and after transplant recipients and1month and3months after transplantationsurvival rate,designed to evaluate MELD score recipients of selecting reasonableoperation time, reduce the mortality and postoperative liver allocation referencesignificance.Objective: Preoperative meld score analysis of infection risk factors post livertransplantation of a month, and meld score is applied to forecast the short-termsurvival rate post liver transplantation.Methods: Retrospective analysis the clinical data of225patients with end-stageliver disease undergone liver transplantation in Fuzhou General Hospital of Nanjingmilitary command Hepatobiliary Surgery Department by MELD score from January2008to January2014. By statistical analysis liver transplantation patients’ age, gender,preoperative liver function, albumin, preoperative Cr, PT and PT INR, TBIL, meldscore, operation time, intraoperative bleeding and transfusion, intraoperative urinaryvolume and total amount without liver period time, quantity of abdomen. Accordingto the presence of infection patients were divided into infection and the infectiongroup, who has ruled out ABO blood group, again a liver transplant, emergency livertransplantation preoperative meld score results and preoperative is infected patients.Meld score indexes from the receptor preoperative laboratory results recently,including bilirubin, PT and INR, creatinine according to meld score were divided intogroup A (meld10or less) and group B (meld>10,20or less), group C (meld>20,30or less), group D (meld>30), analysis and comparison between groups after1month,3months have statistical significance between survival rate.Main Results:1, group A (MELD10or less) and group B (MELD>10,20orless), group C (MELD>20,30or less), group D (MELD>30) four groups ofpreoperative and intraoperative main clinical indicators to compare, in Cr, PT and PTINR, TBIL, blood loss, blood transfusion amount, on the average amount of urine wasstatistically difference (P <0.05).2, infection group and non and infection betweenthe single factor analysis showed that the PT, TBIL, MELD score, Cr, on average,blood loss, blood transfusion amount of urine difference was statistically significant(P <0.05). Two groups in age, gender, etc there was no statistically significantdifference (P>0.05). Multiple factors analysis showed that preoperative high totalbilirubin and increased intraoperative blood transfusion is a risk factor for infection after liver transplantation (P <0.05).3, the incidence of postoperative1month oerallsurial was88.9%(200/225),3months of survival rate was87.1%(196/225). Themeld score10or less, score in10-20, score1months are between20and30patientssurvival rates were91.0%,92.7%and82.1%. Two comparison between the threegroups no statistically significant difference (P value was0.851,0.793and0.851,respectively), meld score>30receptor1months postoperative survival rate of50.0%,compared with the former three groups differences were statistically significant (Pvalue was0.008,0.025and0.008, respectively), the comparison between each3months postoperative survival rate and survival rate similar to1months.Conclusion:1, the MELD score high receptor marked increase the incidence ofinfection after liver transplantation.2, high preoperative bilirubin, preoperativecoagulation function and increased intraoperative blood transfusion is the main riskfactors of infection after liver transplantation.3, MELD score system is not fullypredict postoperative survival rate, there is no linear relationship between, only havereached a point (MELD>30), the survival rate was significantly decreased. |
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