Can the model for end-stage liver disease score replace the indocyanine green clearance test in the selection of right hemihepatectomy in Child-Pugh class A?

Abstract

PurposeTo identify the correlation of the model for end-stage liver disease (MELD) scores with the assessment of the risk of hepatic function after hemihepatectomy in patients with hepatocellular carcinoma (HCC) related to hepatitis B virus (HBV).MethodsA case-control study was performed based on data for 141 consecutive patients who underwent curative right hepatic resection between January 2006 and June 2010.ResultsAll patients were Child-Pugh class A. The mean age of the patients was 50 years (range, 29-73 years). The group included 114 men (80.9%) and 27 women (19.1%). The distribution of MELD scores (median, 7; range, 6-14) and indocyanine green retention rate at 15 minutes (ICG-R15) (median, 9.2%; range, 1.1%-19.5%) showed no significant correlation (P = 0.615). Only one perioperative death (0.7%) occurred within 30 days, which was the result of liver failure by hepatic artery dissection during the Pringle maneuver. Hepatic dysfunction occurred in 25 patients (17.7%) after liver resection. In multivariate analysis, male gender, increased HBV DNA level, and elevated serum aspartate transaminase level were significantly related with hepatic dysfunction. Tumor size and satellite nodule were closely associated with tumor recurrence in HBV-related HCC after right hemihepatectomy and satellite nodule was a predisposing factor for mortality in those patients.ConclusionMELD score does not accurately predict hepatic function after right hemihepatectomy in patients with resectable HBV-related HCC. MELD scores were not correlated with the ICG-R15 values in patients with Child-Pugh class A.

Surgical Treatment of Hepatocellular Carcinoma: Should Resection be Performed According to Barcelona Clinic Liver Cancer Classification?

“…Patients with a MELD score higher than 10 have a significantly increased risk of morbidity and poor outcome after surgery [19,20]. Over the last few years many classifications have been reported [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The Barcelona Clinic Liver Cancer staging and treatment strategy (BCLC) has gained wide acceptance and endorsement because of its stratification capacity and its linkage of staging with treatment indication [22] (Figure 1).…”

“…Additionally, test results may vary between examiners. Nevertheless, in a recent Korean study the attempt to replace ICG by the MELD proved unsuccessful [17].…”

“…MELD scores perform well in predicting death within 3 months in patients awaiting liver transplantation and have been applied in the allocation of donors' livers [9,[17][18]. In addition, the MELD score shows a significant correlation with the degree of metabolic liver functional impairment, and has also been used to predict the postoperative mortality risk of patients undergoing hepatic resection.…”

Potential use of metabolic breath tests to assess liver disease and prognosis: has the time arrived for routine use in the clinic?

“…The ICG test has also proved useful for the evaluation of hepatic reserve prior to resection, and correlated with quantitative hepatic magnetic resonance (MR) relaxometry . MELD does not appear to be an accurate surrogate for ICG‐r15 in patients with compensated cirrhosis undergoing hepatic resection for HCC …”

“…42 MELD does not appear to be an accurate surrogate for ICG-r15 in patients with compensated cirrhosis undergoing hepatic resection for HCC. 43 The galactose elimination capacity (GEC) and lidocaine metabolism tests correlate modestly with MELD and CTP. 44,45 Both lidocaine catabolism and the appearance of its metabolite, monoethylglycinexylidide (MEGX), change in proportion to hepatic injury in animal models.…”