title: Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity.
abstract: 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.
authors: Department of General, Visceral, and Transplantation Surgery, University Hospital Charité, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin 13353, Germany. martin.stockmann@charite.de
authors: Martin
authors: M
authors: Stockmann
authors: Johan F
authors: JF
authors: Lock
authors: Björn
authors: B
authors: Riecke
authors: Karsten
authors: K
authors: Heyne
authors: Peter
authors: P
authors: Martus
authors: Michael
authors: M
authors: Fricke
authors: Sina
authors: S
authors: Lehmann
authors: Stefan M
authors: SM
authors: Niehues
authors: Michael
authors: M
authors: Schwabe
authors: Arne-Jörn
authors: AJ
authors: Lemke
authors: Peter
authors: P
authors: Neuhaus
mesh_terms: 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
chemical_list: D000081:Acetamides; D007202:Indicators and Reagents; C035495:methacetin