Prognostic Value of the Monoethylglycinexylidide Test in Pediatric Liver Transplant Candidates

Abstract

The objective of this prospective study was to assess the prognostic value of dynamic and static liver function tests and clinical symptoms in pediatric patients with chronic end-stage liver disease in a serial examination including three evaluations at 3-month intervals. Of the 24 patients entering the study, six were given transplants within the observation period of 10 months. Of the remaining 18 patients who were considered in the final evaluation, five died before transplantation was possible. The variables included in the analysis were monoethylglycinexylidide (MEGX) formation from lidocaine, bilirubin, albumin, and creatinine serum concentrations, catalytic serum concentration of cholinesterase (CHE), prothrombin time (PT), factors II and V, serum amino acids, body weight, and presence of ascites. In nonsurvivors (n = 5), MEGX serum concentrations 30 min after intravenous administration of lidocaine (1 mg/kg body weight) were < 10 micrograms/L at the first examination. Statistically significant differences between nonsurvivors and survivors were observed for initial MEGX test results (p = 0.0089) and serum bilirubin concentrations (p = 0.009), as well as for the last available MEGX and bilirubin data from each patient (p = 0.017 and 0.016, respectively). At a diagnostic sensitivity of 100%, the corresponding diagnostic specificities for MEGX and bilirubin from the first examination were 77 and 62%, respectively. These data show that consistently low MEGX test results < 10 micrograms/L, obtained 30 min after intravenous administration of lidocaine (1 mg/kg body weight), are a prognostically unfavorable sign in pediatric transplant candidates.

In vivo function tests of hepatic drug-oxidizing capacity in patients with liver disease

“…After i.v. administration it has been shown to be a rapid and sensitive indicator of oxidative drug metabolizing hepatic function in liver disease (77)(78)(79)(80)(81)(82)(83) and in pre-and post-transplant conditions (84)(85)(86)(87)(88)(89). Recently, Shiffman et al (90) reported the results of the lidocaine test performed in 225 patients with chronic hepatitis.…”

Liquid chromatographic method for the determination of lidocaine and monoethylglycine xylidide in human serum containing various concentrations of bilirubin for the assessment of liver function

“…It would be useful to determine the value of the test in evaluating the function of the liver during its various diseases, for the hitherto existing researches [19][20][21] are mainly concentrated on describing, how the test can be used to evaluate the usefulness of the organ for transplantation and to forecast its functions.…”

Clinical importance of non-genetic and genetic cytochrome P450 function tests in liver disease

“…In conclusion, the results of the MEGX formation test fairly accurately reflect the severity of hepatic dysfunction, making it valuable both for quantitative evaluation of liver function and as a prognostic tool in adults with liver disease ( 96). Moreover, liver function tests have recently been used as indices of the status of restoration of hepatic drug‐oxidizing capacity in liver transplantation patients ( 100–106). As stated above, the metabolism of drugs whose biotransformation is mediated by this CYP has been reported to be inhibited (30–50%) in liver disease (cirrhosis) ( 80–91).…”