title: Noninvasive diagnosis of chemotherapy induced liver injury by LiMAx test--two case reports and a review of the literature.
abstract: BACKGROUND
  Chemotherapy-induced liver injury is a well-known phenomenon after neoadjuvant therapy of liver metastasis and contributes to postoperative morbidity and mortality. Still there is no suitable test available to reliably determine functional impairment and hepatic regeneration after chemotherapy.
  
  
  METHODS
  We report two cases of caucasian patients who underwent repeated liver function assessments using LiMAx (maximum liver function capacity), Indocyanine plasma disappearance rate and biochemical liver function parameters in the course of adjuvant oxaliplatin-based chemotherapy. Both patients yielded a decrease from their initial liver function determined by LiMAx. Liver regeneration assessed functional recovery within 4 weeks in case of mild functional impairment after cessation of chemotherapy or within 8 weeks in case of major functional deterioration. Indocyanine plasma disappearance rate and biochemical parameters remained stable or without a clear trend in case of minor functional impairment. This is the first report using a dynamic liver function test to evaluate the impact and recovery from chemotherapy associated liver injury.
  
  
  CONCLUSIONS
  The LiMAx test might be a sensitive tool to diagnose mild functional impairment after chemotherapy when standard liver function tests have remained within normal ranges and might be capable to assess the course of regeneration after chemotherapy. This could be useful to optimize individual chemotherapy-free interval before liver surgery can be carried out safely.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany. jan.bednarsch@charite.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Bednarsch
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany. maximilian.jara@med.uni-muenchen.de.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Jara
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany. lock_j@ukw.de.
authors.forename: Johan Friso
authors.initials: JF
authors.lastname: Lock
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany. maciej.malinowski@charite.de.
authors.forename: Maciej
authors.initials: M
authors.lastname: Malinowski
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany. johann.pratschke@charite.de.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité University Hospital, Augustenburger Platz 1, 13353, Berlin, Germany. martin.stockmann@charite.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Stockmann
mesh_terms: D000081:Acetamides; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D003938:Diagnostic Techniques, Digestive System; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D012680:Sensitivity and Specificity
chemical_list: D000081:Acetamides; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; C035495:methacetin