The lidocaine (MEGX) test as an index of hepatic function: its clinical usefulness in liver surgery.
BACKGROUND
The purpose of this study was to evaluate the clinical usefulness of the lidocaine test, as an index of hepatic function, in the different fields of liver surgery.


METHODS
The lidocaine (MEGX [monoethylglycinexylidide]) test, which was performed in 200 patients with different liver diseases and in 23 organ donors, was compared with common laboratory tests. The MEGX value was related to postoperative complications in patients who undergo liver resection and to the survival of patients with cirrhosis who are awaiting transplantation. In organ donors, the test was related to the outcome of patients who underwent transplantation.


RESULTS
The MEGX value was significantly higher in patients without cirrhosis compared to patients with cirrhosis (77.8 +/- 25 ng/mL vs 35.6 +/- 30 ng/mL; P < .05); among patients with cirrhosis, there was a significant difference between those patients classified Child A and those classified Child B and C (43.3 +/- 25 ng/mL vs 11.5 +/- 7.1 ng/mL; P < .05). The patients classified Child A who underwent liver resection with MEGX value less than 25 ng/mL had a significantly higher rate of postoperative complications compared with other patients (P < .001). Patients with cirrhosis who were awaiting liver transplantation and who had a MEGX value of less than 10 ng/mL had a life expectancy of no longer than 1 year.


CONCLUSIONS
The MEGX test is a reliable index of hepatic function. Patients carrying hepatocellular carcinoma with MEGX value of less than 25 ng/mL have a high risk of liver insufficiency after hepatic resection. Patients with decompensated cirrhosis who have an MEGX value of less than 10 ng/mL should undergo transplantation as soon as possible.
Ercolani
G
G
Department of Surgery and Transplantation, S. Orsola Hospital, University of Bologna, Italy.
Grazi
G L
GL
Callivà
R
R
Pierangeli
F
F
Cescon
M
M
Cavallari
A
A
Mazziotti
A
A
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000097:blood / Q000493:pharmacokinetics; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery; D008107:Liver Diseases / Q000097:blood / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000145:classification / Q000401:mortality; D011237:Predictive Value of Tests; D011517:Prothrombin Time; D000644:Quaternary Ammonium Compounds / Q000097:blood; D012709:Serum Albumin / Q000032:analysis; D014019:Tissue Donors; D014850:Waiting Lists
D000644:Quaternary Ammonium Compounds; D012709:Serum Albumin; D008012:Lidocaine; C001173:monoethylglycinexylidide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin