LIVER - OUTCOMES

J.F. Lock¹, M. Malinowski², S. Biele¹, P. Neuhaus¹, M. Stockmann^1
1Department Of General, Visceral, And Transplantation Surgery, University Hospital Charité, Berlin/GERMANY, ²Department Of General, Visceral And Transplantation Surgery, University Hospital Charité, Berlin/GERMANY

Body: Introduction: Quantitative liver function can be determined by the LiMAx test based on the maximal capacity of cytochrome P450 1A2. Its diagnostic performance has been demonstrated recently in liver surgery and transplantation. Hereby the first analysis of patients with cirrhosis is presented. The aim was to explore the correlation of LiMAx versus MELD and Child-Pugh score. Methods: Seventy-four patients were prospectively enrolled before surgery. The LiMAx test was performed by IV application of 2 mg/kg 13C-methacetin and a consecutive breath analysis of 60 minutes (readout shown in [µg/kg/h]; normal values > 315) as described before (Stockmann et al. Ann Surg 2009). Three patients with acute liver failure and another with cholangiocarcinoma in non-cirrhotic liver were excluded. Nonparametric analysis was done by Spearmen’s rank correlation coefficient and Mann-Whitney test. Data is shown as median with interquartile range. Results: Seventy patients (46 male, 24 female; 54 [48-60] years) with hepatitis C (n=21), alcoholic (n=21), or biliary cirrhosis (n=12), hepatocellular carcinoma (n=6), and other liver diseases (n=10) were analyzed. The reported MELD score was 15 (11-20), the length of time on the waiting list was 36 (10-68) weeks. Histo-pathological examination revealed fibrosis grade VI (n=62), V (n=5) and IV (n=3) according to the classification of Ishak et al. Pretransplant LiMAx was 103 (56-174) µg/kg/h. Patients with carcinoma (n=13) revealed higher LiMAx readouts of 169 (121-232) vs. 95 (46-151) µg/kg/h (P=0.010). LiMAx readouts were correlated with reported MELD (r=0.530; P<0.0001) and with pretransplant labMELD (0.692; P<0.0001). A similar correlation was observed with Child-Pugh score (r=0.707; P<0.0001). In addition, significant correlations were observed for serum bilirubin, albumine, INR but not for creatinine. Conclusion: LiMAx readouts are strongly correlated with established parameters of liver function before transplantation. The LiMAx test might be a valuable tool for the assessment of disease severity in liver cirrhosis.

Disclosure: All authors have declared no conflicts of interest.