Evaluation of Liver Function Tests to Predict Operative Risk in Liver Surgery

Abstract

Despite numerous studies in the past it is not possible yet to predict postoperative liver failure and safe limits for hepatectomy. In this study the following liver function tests ICG-ER (indocyaninegreen elimination rate), GEC (galactose elimination capacity) and MEGX-F (monoethylglycinexylidid formation) are examined with regard to loss of liver tissue and prediction of operative risk. Liver function tests were assessed in 20 patients prior to liver resection and on the 10th. postoperative day. Liver and tumor volume were measured by ultrasound and pathologic specimen and the parenchymal resection rate was calculated. In patients without cirrhosis (n = 10) ICG-ER and MEGX-F remained unchanged after resection, GEC was reduced but did not correspond to the resection rate. Patients with cirrhosis (n = 10) had a significantly lower ICG-ER and GEC before resection than patients without cirrhosis. After resection these tests were unchanged. Patients with liver related complications and cirrhosis (n = 5) had lower ICG-ER and GEC than patients with cirrhosis and no complications. In the postoperative course all liver function tests in these patients were significantly lower compared to preoperative results. Comparing liver function tests ICG serves best to indicate postoperative liver failure. Liver function tests do not correspond with loss of liver tissue.

MARS treatment in posthepatectomy liver failure

“…Our proposal for a MARS treatment regimen, at least for PHLF, is the following. Before treatment the status and severity of liver failure is assessed on the basis of: (i) biochemical parameters like bilirubin, ammonia, urea/creatinine and coagulation factors like prothrombin time, factor V and/or INR, (ii) clinical parameters like hemodynamic stability, diuresis and neurological state like Glasgow Coma Scale and intracranial pressure, (iii) (liver) disease classification: Child‐Pugh score, MELD score and APACHE III score, (iv) CT‐scan to evaluate perfusion of the remnant liver and to measure remnant liver volume, (v) function tests such as indocyanine green (ICG) clearance (9, 22–26). We further advise to extend treatment times to maximal 24 h based on the experience described in the third patient.…”

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

“…These substances include lidocaine, 73 galactose, 95 aminopyrine, 96 , amino acid, 97 , and methacetin. 98 None of these various tests have been proven to be superior than ICG-R15 for the prediction of PHLF-or PHLF-related mortality.…”

Determination of hepatic galactose elimination capacity using 2-[18F]fluoro-2-deoxy-d-galactose PET/CT: reproducibility of the method and metabolic heterogeneity in a normal pig liver model

“…The GEC accurately assessed survival prognosis of patients with acute liver failure [5], chronic liver disease [6,7], and patients undergoing liver resection [8]. More interestingly, it has been shown that quantitative liver function tests such as the GEC are far more predictive of the remaining liver function following partial hepatectomy than measurements of liver volumes [9–11]. …”