Predictive Power of Liver Maximum Function Capacity Test in Transjugular Intrahepatic Portosystemic Shunt Patients: A Pilot Study

Abstract

Background: Transjugular intrahepatic shunt (TIPSS) is placed in patients with variceal bleeding, refractory ascites, and for other indications. Postprocedural liver function-associated complications (LFAC), including hepatic encephalopathy (HE) and liver failure, represent a major setback. Current methods to predict complications are insufficient. Objectives: We investigated in a pilot study of patients prior TIPSS placement whether the risk of LFAC correlates with the functional reserve of the liver, as assessed by liver maximum function capacity (LiMAx) test. Methods: Prospectively we included patients prior TIPSS placement between June 2016 and November 2017 at Saarland University Medical Center. LiMAx was conducted before and after TIPSS placement. Patients with HE prior TIPSS, as well as other factors predisposing to HE, including concomitant sedative drugs, current bacterial infections and sepsis, were excluded. Overt HE (OHE), LiMAx, and laboratory values were assessed before and after TIPSS placement. Data were analyzed in multivari-ate regression and AUROC models. Results: Mean age was 60 ± 8 years. Patients (n = 20) were mainly men (65%), and presented predominantly with Child-Pugh class B (90%). Indications for TIPSS were most commonly refractory ascites or recurrent variceal bleeding. In total, 40% of the patients developed LFAC after TIPSS placement. Expectedly, LiMAx decreased and serum bilirubin increased after TIPSS. LiMAx drop ≥20% was the only parameter predicting the development of LFAC after TIPSS in multivariate regression and AU-ROC analysis. Conclusions: In multivariate regression models and AUROC analysis, a drop in LiMAx predicted the development of LFAC after TIPSS placement. Additional larger studies assessing OHE and early liver failure separately are warranted.

Prognostic Value of the CLIF‐C AD Score in Patients With Implantation of Transjugular Intrahepatic Portosystemic Shunt

“…(21,22) In addition, several instrument-based parameters of liver function and portal hypertension, which could serve to assess patients' prognoses, have emerged in recent years, such as the liver maximum function capacity test (LiMax) or transient elastography. (23,24) Furthermore, several scoring systems have been evaluated for prognostic assessment of TIPS patients. Since its publication in 2000, the MELD score, designed to predict 3-month mortality in TIPS patients, is still likely to be considered the most valid tool to assess prognosis in patients undergoing TIPS implantation.…”

The Liver Maximum Capacity Test (LiMAx) Is Associated with Short-Term Survival in Patients with Early Stage HCC Undergoing Transarterial Treatment

“…The test assesses metabolism of intravenously injected 13C-methacetin by a liver-specific cytochrome P450 1A2-system. In several previous studies, LiMAx was successfully evaluated in patients with different stages of liver fibrosis [ 24 , 25 ], with acute liver failure [ 26 ] and with bacterial sepsis [ 27 , 28 ]. This tool is potentially suitable to select candidates for liver surgery or liver transplantation and to predict the post-operative outcome [ 29 , 30 , 31 ].…”

Liver Function—How to Screen and to Diagnose: Insights from Personal Experiences, Controlled Clinical Studies and Future Perspectives

“…Therefore, an adequate selection of patients suitable for a certain intervention is of fundamental importance. The LiMAx test was able to estimate prognosis with regard to liver surgery, transjugular intrahepatic portosystemic shunt (TIPS) or liver cancer therapies such as transarterial chemotherapy (TACE) or selective intra-arterial radiotherapy (SIRT; unpublished data) and decline from patients who will not benefit from these procedures [ 83 , 96 , 97 , 98 , 99 , 100 , 101 ]. However, it is not only possible to individually decide whether a certain intervention is possible but also to determine an appropriate timepoint.…”