Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity.
OBJECTIVE
To validate the LiMAx test, a new bedside test for the determination of maximal liver function capacity based on C-methacetin kinetics. To investigate the diagnostic performance of different liver function tests and scores including the LiMAx test for the prediction of postoperative outcome after hepatectomy.


BACKGROUND
Liver failure is a major cause of mortality after hepatectomy. Preoperative prediction of residual liver function has been limited so far.


METHODS
Sixty-four patients undergoing hepatectomy were analyzed in a prospective observational study. Volumetric analysis of the liver was carried out using preoperative computed tomography and intraoperative measurements. Perioperative factors associated with morbidity and mortality were analyzed. Cutoff values of the LiMAx test were evaluated by receiver operating characteristic.


RESULTS
Residual LiMAx demonstrated an excellent linear correlation with residual liver volume (r = 0.94, P < 0.001) after hepatectomy. The multivariate analysis revealed LiMAx on postoperative day 1 as the only predictor of liver failure (P = 0.003) and mortality (P = 0.004). AUROC for the prediction of liver failure and liver failure related death by the LiMAx test was both 0.99. Preoperative volume/function analysis combining CT volumetry and LiMAx allowed an accurate calculation of the remnant liver function capacity prior to surgery (r = 0.85, P < 0.001).


CONCLUSIONS
Residual liver function is the major factor influencing the outcome of patients after hepatectomy and can be predicted preoperatively by a combination of LiMAx and CT volumetry.
Stockmann
Martin
M
Department of General, Visceral, and Transplantation Surgery, University Hospital Charité, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin 13353, Germany. martin.stockmann@charite.de
Lock
Johan F
JF
Riecke
Björn
B
Heyne
Karsten
K
Martus
Peter
P
Fricke
Michael
M
Lehmann
Sina
S
Niehues
Stefan M
SM
Schwabe
Michael
M
Lemke
Arne-Jörn
AJ
Neuhaus
Peter
P
D000081:Acetamides / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000368:Aged; D001944:Breath Tests; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007202:Indicators and Reagents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D008099:Liver / Q000503:physiopathology*; D017093:Liver Failure / Q000175:diagnosis* / Q000209:etiology; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000081:Acetamides; D007202:Indicators and Reagents; C035495:methacetin