Application of the Liver Maximum Function Capacity Test in Acute Liver Failure: A Helpful Tool for Decision-Making in Liver Transplantation?
Background. Despite aggressive intensive medical management acute liver failure (ALF) may require high-urgency liver transplantation (LTx). Available prognostic scores do not apply for all patients; reliable tools to identify individuals in need of LTx are highly required. The liver maximum function capacity test (LiMAx) might represent an appropriate option. Referring to a case of ALF after Amanita phalloides-intoxication the potential of the LiMAx-test in this setting is discussed. Presentation of Case. LiMAx was performed in a 27-year-old patient prior to and after high-urgency LTx. In accordance with clinical appearance of hepatic encephalopathy, coagulopathy, and acute kidney failure, the LiMAx-test constituted a fulminant course of ALF with hardly any detectable metabolic activity. Following LTx with a marginal donor organ (95% hepatosteatosis), uptake of liver function was demonstrated by postoperative increase of the LiMAx-value. The patient was discharged from hospital on postoperative day 26. Discussion. ALF often is associated with a critical state of the patient that requires almost immediate decision-making regarding further therapy. Application of a noninvasive liver function test might help to determine the prognosis of ALF and support decision-making for or against LTx as well as acceptance of a critical donor organ in case of a critically ill patient.
Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
Florian Wolfgang Rudolf
FW
Vondran
Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany.
Carsten
C
Schumacher
Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany.
Kai
K
Johanning
Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany.
Björn
B
Hartleben
Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
Wolfgang
W
Knitsch
Department of Respiratory Medicine, Hannover Medical School, 30625 Hannover, Germany.
Olaf
O
Wiesner
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany.
Elmar
E
Jaeckel
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, 30625 Hannover, Germany.
Michael Peter
MP
Manns
Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
Juergen
J
Klempnauer
Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
Hueseyin
H
Bektas
Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany.
Frank
F
Lehner