Donor MEGX test fails to predict graft function after orthotopic liver transplant

Dette, K.; Knoop, M.; Langrehr, Jan M.; Haller, G. W.; Steinmueller, T; Guckelberger, Olaf; Horch, D; Haeusler, Michael

doi:10.1016/s0041-1345(96)00126-1

Cited by 6 publications

(2 citation statements)

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“…Table 1 shows the characteristics of the studies included in the meta-analysis. The quality of all included trials quality was either adequate [1], [3], [5], [6], [19], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39] or good [40], [41], [42]. The studies included (Table 2) patients of which 64.3% of the donors and 54.1% of recipients were male.…”

Section: Resultsmentioning

confidence: 99%

Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

et al. 2008

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IntroductionThe ability to preserve organs prior to transplant is essential to the organ allocation process.ObjectiveThe purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant.MethodsTo identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance.ResultsTwenty-six studies met criteria. Functionally, PNF% = −6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean−9.89535)2−0.0067663*(CIT Mean−9.89535)3, r2 = .625, , p<.0001. Mean patient survival: 93 % (1 month), 88 % (3 months), 83 % (6 months) and 83 % (12 months). Mean graft survival: 85.9 % (1 month), 80.5 % (3 months), 78.1 % (6 months) and 76.8 % (12 months). Maximum patient and graft survival occurred with CITs between 7.5–12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time, % first time grafts and % immunologic mismatches.ConclusionThe results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ.

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Section: Resultsmentioning

confidence: 99%

Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

et al. 2008

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“…The MEGX test did not seem to discriminate patients with minimal liver disease from those with more advanced liver disease as well as the Aminopyrine Breath Test or Galactose Elimination Capacity Test. The MEGX test in liver donors also failed to predict post-graft liver function 9,10 in the recipient. The results of the MEGX test will be affected by changes in liver blood flow (common in recipients of liver transplants) because lignocaine has a high first-pass hepatic extraction, and by administration of drugs that interfere with the CYP450 enzyme system.…”

Section: Lignocainementioning

confidence: 99%

Potential Use of Pharmacological Markers to Quantitatively Assess Liver Function during Liver Transplantation Surgery

Gao

Ramzan

2000

Anaesth Intensive Care

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Early functioning of the transplanted liver is of crucial importance to the recipient. This function may be assessed by measuring the disposition of substances that are mainly eliminated via the liver. None of the agents currently used is ideal for this purpose. Measurement of mono-ethyleneglycinexylidide (MEGX) formation from lignocaine is useful and has been widely used in liver transplantation to assess liver graft function. MEGX formation can be affected by the use of drugs that influence liver perfusion or interfere with the CYP450 enzyme system. Indocyanine green clearance is a convenient method but both blood flow and hepatocellular function affect the test results. Tests of caffeine clearance, galactose elimination capacity and antipyrine clearance all require time-consuming, technically cumbersome and expensive serial blood sampling. The aminopyrine breath test is non-invasive, but gastric emptying and the patient's physical state affect results. The potential hazard of exposure to radioactive compounds limits the wide clinical use of both aminopyrine and erythromycin breath tests. Monitoring the rate of recovery from neuromuscular blockade induced by vecuronium and rocuronium can provide valuable information on liver function.

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The clinical importance of conventional and quantitative liver function tests in liver transplantation

2000

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The advantages and disadvantages of using monoethylglycinexylidide (MEGX), the major metabolite of lidocaine, as a probe of hepatic function in liver transplantation are reviewed. A 'real time' test of liver function should give a measure of current hepatocellular capacity rather than reflect past damage. The hepatic metabolism of lidocaine to MEGX is the basis of a flow-dependent dynamic test of liver function. In pre-transplantation patients, data from this MEGX test support its role in assessing the risk of morbidity and mortality. In assessing the liver transplant donor, there are differences concerning its apparent usefulness and these must be resolved. In the liver transplant recipient, this MEGX test is also useful for measuring real-time hepatic metabolizing activity, and low MEGX values reflect the clinical condition of the patient. At present, however, this test has several limitations. Therefore, a comprehensive evaluation, not only by the MEGX test but also by a combination of other conventional liver function tests (biochemical parameters, etc.), or with histological evaluation, is thought to be desirable for deciding whether a liver transplantation should be carried out or not.

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Donor MEGX test fails to predict graft function after orthotopic liver transplant

Cited by 6 publications

References 4 publications

Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Potential Use of Pharmacological Markers to Quantitatively Assess Liver Function during Liver Transplantation Surgery

The clinical importance of conventional and quantitative liver function tests in liver transplantation

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