Analysis of the effect of pre-transplantation modified model for end-stage liver disease score on the prognosis of patients after heart transplantation

Liu Sheng; Zhou Zhiming; Zhou Qiang; Yang Bin

doi:10.3760/j.issn.1673-4777.2024.12.003

Abstract：Objective To investigate the effect of the modified model for end-stage liver disease(MELD-XI)score on the prognosis of patients after heart transplantation.Methods The clinical data of 192 recipients who underwent single-organ heart transplantation in the 7th People's Hospital of Zhengzhou,Henan Province from May 2018 to July 2023 were retrospectively analyzed.The survival status of all heart transplant recipients within 5 years after operation was used as the state variable,and the preoperative MELD-XI score was used as the test variable.The X-tile software was used to determine the optimal threshold of preoperative MELD-XI score for predicting the postoperative survival of heart transplant recipients.According to the optimal threshold,the recipients were divided into two groups.Kaplan-Meier survival analysis was used to compare the 5-year overall survival rates between the two groups.The perioperative conditions and long-term prognosis of the two groups were compared,and the relationship between clinical indicators under MELD-XI score and the risk of postoperative death was explored.Results X-tile analysis showed that the best diagnostic point of preoperative MELD-XI score in predicting postop-erative survival of heart transplantation patients was 8.3.According to the best diagnostic point of preoperative MELD-XI score,the patients were divided into MELD-XI score＞8.3 group(46 cases)and MELD-XI score ≤8.3 group(146 cases).Kaplan-Meier survival analysis showed that the overall survival rates of heart transplant recipients in the MELD-XI score＞8.3 group were significantly lower than those in the MEID-XI score ≤8.3 group at 1,3,and 5 years postoperatively(P＜0.001).Logistic regression analysis showed that preoperative extracor-poreal membrane oxygenation,donor age,and postoperative ventilator use time were significantly correlated with the risk of death after heart transplantation(all P＜0.05).Cox regression analysis showed that postoperative ventilator use time(hazard rate=1.001,95％confidence interval:1.001-1.001,P＜0.001)was a high risk factor for death of heart transplant recipients.Preoperative hemoglobin(hazard rate=0.970,95％confidence interval:0.955-0.985,P＜0.001)was a protective factor for death in heart transplant recipients.Conclusion Preoperative MELD-XI score can be used to evaluate the risk of postoperative mortality and long-term overall survival in heart transplant recipients.