title: Hepatic lidocaine metabolism and complications of cirrhosis. Implications for assessing patient priority for hepatic transplantation.
abstract: The number of patients awaiting hepatic transplantation continues to exceed organ donation. As a result, many liver transplant candidates will develop life-threatening complications of their liver disease and not survive the pretransplant waiting period. Recent studies have demonstrated that hepatic lidocaine metabolism into monoethylglycinexylidide (MEG-X) can predict pretransplant survival. The present study was performed to determine if MEG-X could also predict pretransplant complications and thereby be useful in stratifying persons being evaluated for hepatic transplantation. A total of 57 patients with biopsy-proven cirrhosis underwent MEG-X testing. Of 57 patients, 30 (53%) developed life-threatening complications of their liver disease--i.e., variceal bleeding, grade II hepatic encephalopathy or worse, and spontaneous bacterial peritonitis. MEG-X values were greater in persons without complications of liver disease than in persons with complications (25.7 +/- 2.9 versus 14.7 +/- 1.4 ng/ml, respectively). No patients with MEG-X greater than 30 ng/ml developed a major complication. No significant difference in any of the standard liver function tests existed between persons who developed complications and patients who did not. In this group of 57 patients, 4 (7%) died from complications of cirrhosis. Mean MEG-X for patients who died (5.5 +/- 1.6 ng/ml) was significantly less (P < 0.05) than observed for other patient groups. All patients who died had MEG-X values below 10 ng/ml. This suggests that MEG-X testing could be an extremely useful test in the evaluation of patients for hepatic transplantation by identifying persons at increased risk for developing complications of chronic liver disease.
authors: Hepatology Section, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298.
authors: M L
authors: ML
authors: Shiffman
authors: R A
authors: RA
authors: Fisher
authors: A J
authors: AJ
authors: Sanyal
authors: L E
authors: LE
authors: Edinboro
authors: V A
authors: VA
authors: Luketic
authors: P P
authors: PP
authors: Purdum
authors: P
authors: P
authors: Raymond
authors: M P
authors: MP
authors: Posner
mesh_terms: D000328:Adult; D000368:Aged; D000075202:Contraindications; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives / Q000097:blood / Q000378:metabolism*; D008099:Liver / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
chemical_list: D008012:Lidocaine; C001173:monoethylglycinexylidide