【Abstract】Objective To introduce the birth and development of model of endstage liver disease (MELD) and evaluate its effect on liver transplantation(LT) as a new scoring system. Methods Literatures of MELD applied in LT were analyzed retrospectively. Results MELD scoring system was used for predicting the prognosis of patients with endstage liver disease and the death risk of candidates on waiting LT extensively and the order of organ sharing was determined by its predicable results. Conclusion MELD has been had a successful initial implementation for predicting the shortterm survival probability and mortality in patients with endstage liver disease, and meeting the goal of providing a system of allocation that emphasizes the urgency of the candidate while diminishing the reliance on waiting time, which has been proven to be a powerful tool for auditing the liver allocation system.
ObjectiveTo analyze the incidence of bacterial lung infection after orthotopic liver transplantation and its risk factors. MethodsNinety-six patients with end-stage liver disease who underwent liver transplantation from Jan. 2010 to Jun. 2012 in our hospital were retrospectively analyzed. The relationship of preoperative, intraoperative, and postoperative variables with early postoperative bacterial lung infection was explored by multivariate non-conditional logistic regression. ResultsTwenty-nine cases of 96 cases after liver transplantation occurred early bacterial lung infection, and the infection rate was 30.21%(29/96), in which G-aerobic bacteria infection accounted for 65.52%(19/29), and G+ aerobic bacteria accounted for 34.48%(10/29). Preoperative model for end-stage liver disease score(OR=2.165, P=0.001), intraoperative blood transfusion(OR=1.952, P=0.003), average of plasma creatinine during 3 days after operation(OR=1.913, P=0.001), liquid negative balance time during 3 days after operation(OR=0.916, P=0.023), and postoperative hospital stay(OR=1.923, P=0.003) were all associated with early postoperative bacterial lung infection. ConclusionsRetrograde reperfusion in orthotopic liver transplantation patients are susceptible to bacterial lung infections. Improving basic status before operation, controlling volume of intraoperative blood transfusion, the volume of transfusion, and postoperative hospital stay, and improving renal function can reduce incidence of early postoperative bacterial lung infection.
Objective To investigate the changes of indocyanine green retention rate at 15 minutes (ICGR15) of autologous peripheral blood CD34+ hematopoietic stem cells transplantation in end-stage liver disease (end-stage liver, disease, ESLD) patients with different Child-Pugh grades during before and after transplantation of 3, 6, 12, 36, and 60 months. Methods The CD34+ hematopoietic stem cells transplantation were performed in 60 cases of advanced liver cirrhosis with different Child-Pugh grades who were ineffectively treated with strictly conservative treatment and complied with the criterion of liver transplantation. The ICGR15 were performed before transplantation and in 3, 6, 12, 36 and 60 months after transplantation. And the results of each time point in each Child-Pugh classification group were compared, and the rate of change of ICGR15 value were compared between each Child-Pugh classification group. Results The ICGR15 values of the Child-Pugh grading groups all decreased with time. In Child A group, there were respectively significant differences between the 6 months, 12 months, 36 months, and 60 months groups after transplantation and preoperative and 3 months groups after transplantation (P<0.05), but there was no significant difference between preoperative and 3 months group after transplantation (P>0.05), and there was significant difference between the 12 months and the 60 months group after transplantation (P<0.05). As same as Child A group, there were also significant differences between that time groups in the Child B group (P<0.05), but there were also significant differences between the 3 months group after transplantation and preoperative (P<0.05), and there were respectively significant differences between the 6 months and 12 months, 36 months, and 60 months group after transplantation in the Child B group (P<0.05). Also in the Child C group, there were significant differences between that time groups (P<0.05), but there was no significant difference between preoperative and 3 months group after transplantation (P>0.05), and there were respectively significant differences between the 6 months and 12 months, 36 months, and 60 months group after transplantation (P<0.05). There was no significant difference in the rate of ICGR15 between Child-Pugh classification groups. Conclusion Autologous peripheral blood CD34+ hematopoietic stem cells transplantation can effectively improve the liver function reserve capacity of ESLD patients and improve the safety of operation for a long time.
ObjectiveTo figure out the factors affecting the prognosis of liver transplantation and the research progress on methods for predicting the prognosis of liver transplantation so as to provide guidance and reference for the distribution of liver sources and the perioperative treatment of liver transplantation.MethodThe literatures related to the factors influencing the prognosis of liver transplantation and the methods in predicting the prognosis were searched in the PubMed, CNKI, Wanfang, and other databases and the results were analyzed and summarized.ResultsThe liver transplantation was an effective method in the treatment of end-stage liver diseases. The main factors affecting the prognosis of liver transplantation included the change of internal environment, systemic inflammatory response, and general systemic conditions. On the basis of Model for End-stage Liver Disease (MELD), the new prediction model built in combination with the blood sodium ion, lactate, muscle mass, or reticulocyte count and hemoglobin concentration had improved the prognostic prediction ability of liver transplantation.ConclusionsIt is possible to predict the prognosis of patients with liver transplantation more accurately by selecting a more targeted prediction model combined with the factors affecting the prognosis of liver transplantation. It might provide a reference for perioperative management and treatment and make the limited liver source play the most role and save more lives.