title: Physiological and biochemical basis of clinical liver function tests: a review.
abstract: OBJECTIVE
  To review the literature on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery.
  
  
  BACKGROUND
  Postoperative liver failure is the major cause of mortality and morbidity after partial liver resection and develops as a result of insufficient remnant liver function. Therefore, accurate preoperative assessment of the future remnant liver function is mandatory in the selection of candidates for safe partial liver resection.
  
  
  METHODS
  A MEDLINE search was performed using the key words "liver function tests," "functional studies in the liver," "compromised liver," "physiological basis," and "mechanistic background," with and without Boolean operators.
  
  
  RESULTS
  Passive liver function tests, including biochemical parameters and clinical grading systems, are not accurate enough in predicting outcome after liver surgery. Dynamic quantitative liver function tests, such as the indocyanine green test and galactose elimination capacity, are more accurate as they measure the elimination process of a substance that is cleared and/or metabolized almost exclusively by the liver. However, these tests only measure global liver function. Nuclear imaging techniques ((99m)Tc-galactosyl serum albumin scintigraphy and (99m)Tc-mebrofenin hepatobiliary scintigraphy) can measure both total and future remnant liver function and potentially identify patients at risk for postresectional liver failure.
  
  
  CONCLUSIONS
  Because of the complexity of liver function, one single test does not represent overall liver function. In addition to computed tomography volumetry, quantitative liver function tests should be used to determine whether a safe resection can be performed. Presently, (99m)Tc-mebrofenin hepatobiliary scintigraphy seems to be the most valuable quantitative liver function test, as it can measure multiple aspects of liver function in, specifically, the future remnant liver.
authors: Academic Medical Center, Amsterdam, The Netherlands. l.t.hoekstra@amc.uva.nl
authors: Lisette T
authors: LT
authors: Hoekstra
authors: Wilmar
authors: W
authors: de Graaf
authors: Geert A A
authors: GA
authors: Nibourg
authors: Michal
authors: M
authors: Heger
authors: Roelof J
authors: RJ
authors: Bennink
authors: Bruno
authors: B
authors: Stieger
authors: Thomas M
authors: TM
authors: van Gulik
mesh_terms: D015415:Biomarkers / Q000097:blood; D004396:Coloring Agents; D054893:Cone-Beam Computed Tomography; D006305:Health Status Indicators; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D008099:Liver / Q000000981:diagnostic imaging / Q000502:physiology*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control*; D008111:Liver Function Tests / Q000379:methods*; D018579:Patient Selection; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015415:Biomarkers; D004396:Coloring Agents; D019275:Radiopharmaceuticals; D007208:Indocyanine Green