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A rapid and accurate new bedside test to assess maximal liver function: a case report

BACKGROUND: In liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance. The up-to-date, preoperative prediction of residual liver function has thus far been limited. As post-hepatectomy liver failure is a major cause of mortality, a new and simple...

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Autores principales: Müller, Sascha A, Tarantino, Ignazio, Corazza, Marcello, Pianka, Frank, Fornaro, Jürgen, Beutner, Ulrich, Lüthi, Cornelia, Schmied, Bruno M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639859/
https://www.ncbi.nlm.nih.gov/pubmed/23618221
http://dx.doi.org/10.1186/1754-9493-7-11
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author Müller, Sascha A
Tarantino, Ignazio
Corazza, Marcello
Pianka, Frank
Fornaro, Jürgen
Beutner, Ulrich
Lüthi, Cornelia
Schmied, Bruno M
author_facet Müller, Sascha A
Tarantino, Ignazio
Corazza, Marcello
Pianka, Frank
Fornaro, Jürgen
Beutner, Ulrich
Lüthi, Cornelia
Schmied, Bruno M
author_sort Müller, Sascha A
collection PubMed
description BACKGROUND: In liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance. The up-to-date, preoperative prediction of residual liver function has thus far been limited. As post-hepatectomy liver failure is a major cause of mortality, a new and simple bedside test (LiMAx) has been developed to predict postoperative liver function in conjunction with preoperative volumetric analysis of the liver. CASE PRESENTATION: A 45-year-old patient presented with a cecal carcinoma and a large synchronous liver metastasis for major liver surgery. Liver function was determined by the LiMAx-test for the enzymatic capacity of cytochrome P450 1A2, which is ubiquitously and solely active in the liver. A solution of 2 mg/kg body weight (13)C-labeled methacetin was injected as a bolus into an intravenous catheter and, thereafter, was metabolized into acetaminophen and (13)CO2 and pulmonarily exhaled. The analysis of the (13)CO2/(12)CO2 ratio was performed using online breath sampling over a period of maximally 60 minutes. Based on this test, a value of more than 315 μg/kg/h represents normal liver function. A laparoscopic right hemihepatectomy was planned during virtual resection with a residual liver volume of 48% and a preoperative anticipated residual LiMAx of 301 μg/kg/h. After successful resection, the initial postoperative LiMAx value was 316 μg/kg/h, indicating good liver function and a correct prediction of the outcome. CONCLUSION: In the presented patient, residual liver function could be accurately predicted preoperatively using a combination of the new LiMax test with CT-volumetry. This test might significantly improve preoperative evaluation and postoperative outcomes in liver surgery.
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spelling pubmed-36398592013-05-01 A rapid and accurate new bedside test to assess maximal liver function: a case report Müller, Sascha A Tarantino, Ignazio Corazza, Marcello Pianka, Frank Fornaro, Jürgen Beutner, Ulrich Lüthi, Cornelia Schmied, Bruno M Patient Saf Surg Case Report BACKGROUND: In liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance. The up-to-date, preoperative prediction of residual liver function has thus far been limited. As post-hepatectomy liver failure is a major cause of mortality, a new and simple bedside test (LiMAx) has been developed to predict postoperative liver function in conjunction with preoperative volumetric analysis of the liver. CASE PRESENTATION: A 45-year-old patient presented with a cecal carcinoma and a large synchronous liver metastasis for major liver surgery. Liver function was determined by the LiMAx-test for the enzymatic capacity of cytochrome P450 1A2, which is ubiquitously and solely active in the liver. A solution of 2 mg/kg body weight (13)C-labeled methacetin was injected as a bolus into an intravenous catheter and, thereafter, was metabolized into acetaminophen and (13)CO2 and pulmonarily exhaled. The analysis of the (13)CO2/(12)CO2 ratio was performed using online breath sampling over a period of maximally 60 minutes. Based on this test, a value of more than 315 μg/kg/h represents normal liver function. A laparoscopic right hemihepatectomy was planned during virtual resection with a residual liver volume of 48% and a preoperative anticipated residual LiMAx of 301 μg/kg/h. After successful resection, the initial postoperative LiMAx value was 316 μg/kg/h, indicating good liver function and a correct prediction of the outcome. CONCLUSION: In the presented patient, residual liver function could be accurately predicted preoperatively using a combination of the new LiMax test with CT-volumetry. This test might significantly improve preoperative evaluation and postoperative outcomes in liver surgery. BioMed Central 2013-04-25 /pmc/articles/PMC3639859/ /pubmed/23618221 http://dx.doi.org/10.1186/1754-9493-7-11 Text en Copyright © 2013 Müller et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Müller, Sascha A
Tarantino, Ignazio
Corazza, Marcello
Pianka, Frank
Fornaro, Jürgen
Beutner, Ulrich
Lüthi, Cornelia
Schmied, Bruno M
A rapid and accurate new bedside test to assess maximal liver function: a case report
title A rapid and accurate new bedside test to assess maximal liver function: a case report
title_full A rapid and accurate new bedside test to assess maximal liver function: a case report
title_fullStr A rapid and accurate new bedside test to assess maximal liver function: a case report
title_full_unstemmed A rapid and accurate new bedside test to assess maximal liver function: a case report
title_short A rapid and accurate new bedside test to assess maximal liver function: a case report
title_sort rapid and accurate new bedside test to assess maximal liver function: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639859/
https://www.ncbi.nlm.nih.gov/pubmed/23618221
http://dx.doi.org/10.1186/1754-9493-7-11
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